Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution.
[1]: https://www.dmp.no/nyheter/behov-for-smertestillende-slik-ve...
[2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
That's a pretty apt explanation for why pain probably evolved via natural selection, but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain. I don't think it's a hubristic affront to biology to feel a bit of soreness, note it, then take the painkillers.
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?
It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.
> In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.
So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
Americans' relationship with painkillers is absolutely unhinged.
water?
EDIT: I see it's a thing. Salt, water and sugar.
Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
> but it does absolutely nothing with actual pain. It is placebo at best.
This is simply false.
When I took ibuprofen it did actually made an actual real change.
It is only packet size restricted in supermarkets, you can still buy bulk packs from chemists.
For ibuprofen you need to go to a pharmacy.
It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Double blind placebo controlled trials have shown that acetaminophen/paracetamol is superior to a placebo at controlling pain.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
> The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...
That's for pyroglutamic and glutamic acid esters of paracetamol: https://pubmed.ncbi.nlm.nih.gov/8799871/
and more general analogs apparently can also be designed to not produce NAPQI:
> Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40 (Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).
https://pubs.rsc.org/zh-tw/content/articlepdf/2024/ra/d4ra00... p. 9702.
These would probably require trials, though.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.
20 not-especially-large tablets
Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.
I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.
I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.
It's the usual public health balancing act of help vs harm.
You can overdose on water too, they haven't banned 5-gallon jugs (yet).
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
Also applies to most similar phrases ending in -proof. Should be eye-opening.
One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter.
I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:
1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.
2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.
"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.
Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.
I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.
An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.
Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.
The med students I've known have been some of the most insufferable people I've met.
I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.
I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there
Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.
I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.
I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.
0: https://plato.stanford.edu/archives/win2021/entries/galen/#M...
We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.
Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)
Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.
The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.
I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about
The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
The benefits stack, the side effects don't.
So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"
Also, people with memory issues...
I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
> There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
But it is. The faster I go, the earlier I arrive at a destination. The more I eat, the later I'll be hungry again. The more I pay, the more I can buy. The more I smile, the more people smile back. It's all-pervasive in life, and "more is better for many things" is just obviously true. Not for all things and there are limits of course.
> More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
A higher dose gets broken down slower, as in, the threshold below which the effect is reduced is reached later. Not a reason to damage your kidneys and better take smaller doses more often, but it's not fully accurate to say there is a limit and anything above has zero effect.
Acetaminophen worked far, far better than all these. It worked so well, but i wanted to be careful to limit myself to 3000mg a day, so I took 1 500mg pill every 4 hours for a few days while awaiting surgery. It's the only thing that got me through it. Even a epidural lumbar steroid injection didn't help...
If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.
This article is explicitly considering usage as painkiller.
You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
So don't be the "smarter" person. Do as your doctor says and if you have doubts, consult another doctor before just doing what you think is safe, but actually isn't.
Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
And from what I see in pharmacies, you would rarely see a "cough syrup" called just like that if it contains paracetamol. It would usually be marketed as a flu-relief all-around symptom relief.
Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen).
We'd look on at the US where you were taking Advil like candy in confusion.
One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
Can confirm this is true in India.
Paracetamol is widely used. Paracetamol + Ibuprofen is more common than Ibuprofen by itself.
The same is the case in the Netherlands.
Acetoaminophen also has issues for people with weaker stomachs (I can attest), and will come with additional medication to cover these effects as needed. The whole "Is it safe yes/no" table has many asterixes and might be outright false depending on the how you look at it.
As usual, it's just complicated.
I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.
But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient.
(COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research."
Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin.
https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen...
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything).
EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
This is not my experience. After moving to Germany from the UK, I feel like people take and expect Ibuprofen far more often than Paracetamol. It seems like the first port of call for colds and general headaches, with Paracetamol being treated with some suspicion, despite it being far more effective in my experience for certain things (I've taken a lot of Ibuprofen and other NSAIDs in my time so am quite familiar with how they affect me).
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
0. https://www.researchgate.net/publication/382639515_Ibuprofen...
I Am Not A Doctor And This Is Not Medical Advice.
(I think?).
Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked.
In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
So we should not be too quick to dismiss the pain of others.
As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
What you describe in an interesting contrast to the situation in The Netherlands. Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol.
[1]: https://99percentinvisible.org/episode/579-towers-of-silence...
Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before.
I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol...
I don't understand it, but it is what it is.
The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
But yet in some countries pediatricians will libreally prescribe it to toddlers
[1] https://www.bmj.com/content/368/bmj.m1086
Also from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution."
https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.1451...
56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion."
So I guess it depends on if you think 56,000 is low or not.
Source: "Acetaminophen Toxicity", David H. Schaffer; Brian P. Murray; Babak Khazaeni. 2026/02/19. https://www.ncbi.nlm.nih.gov/books/NBK441917/
That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
Why? Because Celebrex (celecoxib) is a dangerous drug which can cause irreparable harm (heart attacks and related) if taken for long periods. In fact, its sister drug Vioxx (rofecoxib) was banned and Merck had to pay billions in damages. There's more here: https://news.ycombinator.com/item?id=47835635#47862704
Whilst Celebrex is safer than Vioxx it still has the same side effects profile as the latter.
I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
Excerpt:
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305
Why should I trust someone who doesn’t test properly but just suspects?
Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page).
I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol).
It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole).
I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.
Acetaminophen = Paracetamol
Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet.
Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1]
On the other hand, if in the early 2000s you were to share those concerns with certain doctors, they would propose a more effective and non addictive alternative to morphine instead. Only the first part of what they would tell you was true.
That's NAC (N-acetylcysteine, C5H9NO3S), mentioned in the article many times.
Context: I’m t1 diabetic.
I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl).
Turns out this is a common effect, but a relatively new discovery that no one told me about.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
Have gotten into a habit of keeping a note of which med when on the fridge.
To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous.
I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things.
For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself.
I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative.
1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too.
Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though.
But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
[1] https://www.thisamericanlife.org/505/use-only-as-directed
[2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...
That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling.
I take ibuprofen for localized intense pain.
I take aspirin for headaches and sore muscles.
it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all.
i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help.
i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps.
except for ibuprofen. 400-600mg kills it every time.
at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
This is semi recent research on how it might be blocking pain
[1] https://pubmed.ncbi.nlm.nih.gov/40819833/
[2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...
> Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die.
Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills
> that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this.
Could be but I think a lot of doctors underestimate the dangers of paracetamol as well
All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition?
"Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen
Also, some countries do add a notice for kidney problems for Paracetamol as well (e.g.) https://www.medicines.org.uk/emc/product/5164/pil
An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
Acetaminophen is the only medication of its kind approved for infants under six months because the liver develops faster than the kidneys.
You take too much and it can give you a fever, which might entice you to take more aspirin. Nasty.
Obligatory Reye's mention:
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-b...
and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first?
Further reading:
https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-ca...
And for those of you with kids: https://www.nhs.uk/conditions/kawasaki-disease/
Of course it's not all bad. There's even some discussion of anti-cancer potential. How might this work? One hypothesis: https://www.nature.com/articles/srep45184
This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.
