Paracetamol, also known as Acetaminophen, and sold under the brand name Tylenol in the USA, is an analgesic medication used to treat mild pain and fever.
Ibuprofen is a nonsteroidal anti-inflammatory drug used to relieve pain, fever, and inflammation.
These two drugs are some of the most widely used medications in the Western world today, both cheaply produced and sold, with millions of users daily. But an important question is whether they even do anything beneficial or could their benefits be considered as placebo?
Both are used to treat fevers and lower them slightly, but potentially having a fever means your body is combating an infection and common sense often dictates that you should run a fever, rather than try to suspend it. A prolonged fever in children or the elderly might be cause for concern, but at that point, you would be seeking direct medical advice and possibly more appropriate medications.
A problem with many of the studies in the systematic reviews for these medications is that they only monitored single doses, and not repeated dosages. Most people use medications repeatedly over weeks and months, some people for years.
Paracetamol
For chronic back pain, paracetamol; according to various studies, performs the same as a placebo.
Cochrane Systematic Review – Paracetamol for Back Pain
Meta Analysis – Paracetamol versus placebo for knee and hip osteoarthritis
However other systematic reviews pose that whilst there is insufficient evidence for firm conclusions, that for 4 conditions, efficiency evidence was moderate to strong, albeit there still being strong evidence that it is not effective for lower back pain.
Systematic Review – The efficacy and safety of paracetamol for pain relief
Another study showed that intravenous paracetamol was effective for post operative pain, thus giving some confirmation for paracetamol’s intravenous usage for acute purposes. Interestingly it would be good to know whether oral or intravenous have the same effect. Onset of pain relief would logically be faster intravenously, but is the pain relief the same once both administration pathways have set in?
It’s also thought by some experts that paracetamol acts as a dampener on the central nervous system to allow other pain medications to work better, which is why it’s combined with medications such as codeine; marketed as Co-Codamol/Paramol , but this idea is not fundamentally proven too well when considering it could still just be the placebo affect at work.
Controversially what paracetamol is proven to do, is damage the liver in high dosages. Above therapeutic dosages it becomes a poison that people use to commit suicide.
Ibuprofen
Ibuprofen on the other hand, has plenty of studies showing it does reduce inflammation and the pain resulting from that inflammation. However, similar to a fever, inflammation is a body’s response to infection or injury, and it’s not necessarily a bad thing unless it’s chronic or causing other symptoms. The downside of Ibuprofen is that it can damage the gut lining and worsen various conditions involved with ulcers or other digestive problems. Ibuprofen is therefore somewhat of a risky medication for certain people, yet it’s still widely used as an OTC medication. Because of this it is often more ideal to use an ibuprofen as a cream or spray, to directly apply on an injured area instead of using the oral medication.
The issue that these generic low impact medications pose is that ; people often take them to avoid mild discomfort. The discomfort of a fever, or the discomfort of an ache or sore throat. But many times, just suffering for a short time, can potentially provide a better outcome than trying to solve the discomfort immediately. By reducing your fever or inflammation, you might be prolonging the cause of the fever or inflammation.
Considering painful acute conditions, paracetamol and ibuprofen must be considered differently. Especially in a situation such as pregnancy pain or a severe injury. The usage of strong painkillers can be detrimental instead of helpful, and therefore these milder medications can serve as a dampener for higher levels of acute pain.
One study showed that dosages of 400mg, 600mg and 800mg in the ER were all comparable for pain relief. Posing an interesting question about how these painkillers work if higher dosages don’t lead to higher pain relief.
Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain
The following overview concludes the benefits of Ibuprofen across many different conditions and it’s relative safety ;
An Overview of Clinical Pharmacology of Ibuprofen
Long term use
Now with chronic conditions, this previous point isn’t as salient. But the issue with chronic conditions, are whether these medications are safe for long term use.
On the whole, studies seem to show that both are fairly safe for long term use, as long as therapeutic doses are adhered to.
However many people consume these medications long term, without consulting a doctor.
A study on patients with hypertension (high blood pressure), found that prolonged use of paracetamol caused an increase in blood pressure.
Clinical Study – Regular Acetaminophen Use and Blood Pressure in People With Hypertension
People with liver issues or alcohol addiction can clearly suffer more damage from taking high dosages of paracetamol every day. People with chronic digestive issues, pose an issue of worsening their condition through such complications as ulcers bleeding or worsening digestive problems.
What conclusions are there?
There isn’t any firm conclusion on this issue still. The medical profession is often quite stuck in situations where a patient expects them to provide medication for their ailment, no matter what. OTC meds that have low chances for side-effects are therefore quite attractive to administer in many scenarios. The problem arises when patients take these medications long term without considering other health issues. These medications have been the foremost choices of anyone with a headache, soreness or fever. People want to avoid suffering even mild symptoms, and these medications fill that void where doctors will be unwilling to prescribe a strong painkiller that could lead a patient to addiction.
For more reading :
What’s the point of paracetamol
If paracetamol is ineffective for most conditions, what next?
Why paracetamol is a suitable first choice for treating mild to moderate acute pain in adults
