Everyday we are bombarded with television and print ads extolling the wonders of Tylenol, active ingredient acetaminophen, in the treatment of all types of pain. The typical advertisement scenario is a man or woman grabbing their low back in pain - perhaps a little red highlighting over the area of pain and some dramatic music - followed by their reaching for a bottle of quick-fix. Even more shocking, considering the amount of evidence showing the negative and potentially deadly effects of chronic acetaminophen use, is the scenario showing the the person with obvious chronic, daily low back pain, with the implication that they pop a few pills everyday for a lifetime of pain-free living - although with the fine print caveat to follow the directions on the label and use only as advised by a physician, both of which warn against long-term use because it can kill you. While no therapy comes without some risk, we must always weigh those risks against the potential benefits to make an informed decision both as physicians and patients. So given the well documented risks, what does the evidence say about the benefits of using Tylenol to treat low back pain - the condition most commonly associated with visits to both the medical doctor and chiropractor?