Schreijenberg M, Lin CWC, Mclachlan AJ, et al. - Considering the Paracetamol for Acute Low Back Pain (PACE) trial demonstrating no effect of paracetamol compared with placebo in acute low back pain (LBP) but with noncompliance as a potential limitation, researchers examined the efficacy of paracetamol in acute LBP among compliers. They used individual participant data from the PACE trial, they calculated the complier average causal effect, intention-to-treat, and per-protocol estimates for pain intensity (primary), disability, global rating of symptom change, and function (all secondary) after 2 weeks of follow-up. Intake of an average of at least 4 of the prescribed 6 tablets of regular paracetamol per day (2,660 mg in total) during the first 2 weeks after enrolment defined the compliance in this trial. They performed exploratory analyses using alternative time points and definitions of compliance. Using the primary time point and definition of compliance, they identified no clinically relevant mean between-group differences in pain intensity on a 0 to 10 scale. Findings support the inefficacy of paracetamol for acute LBP even for patients who comply with treatment. This emphasizes that patients should be provided with advice and reassurance in the management of acute LBP without the addition of paracetamol.