They are two essential pain relievers in any first aid kit. We pull one of them when a pain grips us, but often the choice is not the right one. Experts clarify which is better at all times

What is pain? Surely, it is easier to ‘relive’ this symptom than to find the words to define it. Fortunately, the International Association for the Study of Pain (IASP) has been able to find 18 terms that express what pain is: “An unpleasant sensory and emotional experience associated or similar to pain associated with actual or potential tissue damage.” 

Easy? No, and the irrefutable proof is that 40 years have passed since this definition, issued in 2020, and the previous one, in 1979.

In addition, the IASP accompanies the definition with six annotations; the first one is that “pain is always a personal experience that is influenced by biological, psychological and social factors.” 

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In other words: everyone experiences pain in their own way. Now, what is common to the vast majority of people is that we seek relief, with drugs, herbs, relaxation techniques, and whatever. 

False safety

According to experts:

Experts confirm that “ibuprofen and paracetamol are two of the drugs most consumed routinely and without going through the doctor’s clinic”, and we do not know their possible adverse effects. 

Regarding the first, they highlight that it can affect the kidney and that it increases the risk of suffering from cardiovascular problems, and about paracetamol, they warn that “the main risk of misuse is liver damage.”

Another common mistake is that, in case of need, we indiscriminately throw away the analgesic that we have closer to hand, and we associate paracetamol with weaker and safer than ibuprofen, and of course than aspirin. 

With this, we show that we do not really know these drugs as well as we think and that we do not use them correctly.

What are they and how do they work?

“Paracetamol is an analgesic and antipyretic that does not have anti-inflammatory properties. Its exact mechanism of action is unknown, although it is known that it acts at the central nervous system level and, to a lesser degree, by blocking the generation of the pain impulse at the peripheral level,” as explained by doctors.

They describe ibuprofen as “an anti-inflammatory [non-steroidal anti-inflammatory NSAID], analgesic and antipyretic that acts by blocking the synthesis of prostaglandins (substances that play an essential role in the appearance of fever, pain and inflammation).

Are they just as safe?

There is a generalized idea that paracetamol has fewer adverse effects, and experts acknowledge this:

Specialists emphasize that there are certain circumstances that require special care with the use of ibuprofen. Specifically, it refers to uncontrolled hypertension, congestive heart failure, established ischemic heart disease, peripheral arterial disease and / or cerebrovascular disease. These patients “should only be treated with ibuprofen after careful evaluation and high doses should be avoided.” 

And it should be used with caution in people who have had liver or kidney disease, and especially if they are taking diuretics.

Obviously, these warnings do not affect healthy people, but in them “it is recommended to avoid taking NSAIDs for more than one consecutive week”, although “there really is no completely safe number of days of use and it is the doctor who should assess the need for treatment, the maximum daily dose and a maximum number of days of daily consumption”.

Paracetamol, although safer, is not without its limitations either. According to anesthesiologists, “it should not be taken for long periods of time and not at high doses (4 grams daily by mouth)”.

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Domestic first aid kit

The messages against self-medication are repeated and something has been gained in recent years by prohibiting the sale of certain drugs without a prescription (for example, ibuprofen 600 mg or packages of more than 12 tablets of paracetamol of 650 mg or 1 g). The correct thing to do would always be to consult a specialist (doctor or pharmacist) “even if it is a known pain or similar to other episodes.”

Still, we are not resigned to doing without some painkillers in our medicine cabinet. Which ones should we have? “Those that are indicated by your doctor for the painful picture that occurs at a certain time for a specific patient”. And of course, aspirin has no place because “there are alternative drugs with better safety profiles.”

To each pain, its pill

With the utmost respect for their indications, we ask the coordinator of the International community to clarify what we should take for some of the most common complaints:

• Pain mild headache: paracetamol.
• Severe headache: ibuprofen / naproxen.
• Neck and back pain due to muscle overload: ibuprofen because it is anti-inflammatory.
• Joint pain: ibuprofen for being anti-inflammatory.
• Pain Toothache: ibuprofen for being anti-inflammatory.
• Mild/moderate fever: paracetamol.
• Abdominal pain: it depends on the cause, but “in general you should avoid ibuprofen.”
• Postoperative pain: paracetamol alternating with ibuprofen or more usually with dexketoprofen (an NSAID from the same ibuprofen family with faster initial effect).

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The special case of covid-19

In the initial days of the COVID-19 pandemic, news spread that treating symptoms with ibuprofen could aggravate the disease. Experts deny this hypothesis again:

The guidelines recommend the use of paracetamol for the symptomatic treatment of fever as a first alternative. However, “there is also no evidence to contraindicate the use of ibuprofen in the treatment of minor symptoms.”

In both cases, the drugs should be used at the lowest dose capable of controlling symptoms.

What is better after getting vaccinated?

Vaccination against covid-19 is progressing rapidly and the experience of the millions of vaccinated shows that mild adverse effects are common. To alleviate them, the advice of the member of the International Society of Pain are:

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• Paracetamol is preferred for post-vaccination flu-like or pseudo-covid symptoms.
• If there is local inflammation in the area of ​​the injection site, the use of ibuprofen for a limited time can be evaluated, “always under medical criteria and assessing each case individually.”

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