RT Journal
A1 Williams C, Maher CG, Hancock MJ, McLachlan AJ, McAuley JH, Latimer J
T1 APpropriate discard of “best” practice guidelines for acute low back pain—reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2010
FD June 28
VO 170
IS 12
SP 1087
OP 1088
DO 10.1001/archinternmed.2010.191
UL http://dx.doi.org/10.1001/archinternmed.2010.191
AB 
In LBP management, NSAIDs are effective, but no more than paracetamol, which has fewer adverse effects.2 Schilling et al3(p19) highlight that paracetamol “is generally considered safe, but high doses can be toxic.” Their report identifies that paracetamol-related toxic effects occur with ingestion of excessive doses, knowingly or unknowingly, or when contraindication or precautions are present. While other reports of paracetamol toxicity exist,4 these cases reveal multiple causative factors and fail to implicate paracetamol as causing significant toxic effects at recommended doses.5 Mortensen and Cullen5(p1482) state “unfortunately, the extensive literature on the subject of chronic acetaminophen toxicity includes opinions drawn from unsubstantiated case reports.”