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?
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
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?
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.
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.
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.
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
water?
EDIT: I see it's a thing. Salt, water and sugar.
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
Sodium chloride 2.6 gr/l
Glucose, anhydrous 13.5 gr/l
Potassium chloride 1.5 gr/l
Trisodium citrate, dihydrate 2.9 gr/l
glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
1 liter (or 4.25 cups) of water
1/2 a teaspoon of salt (3 gr)
2 table spoons of sugar (30 gr) OR 1 table spoon of glucose (15 gr)
[0] https://en.wikipedia.org/wiki/Oral_rehydration_therapy
[1] https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote...
[2] https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1 page 12 of the linked on that page (labeled as page 3)
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.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
Americans' relationship with painkillers is absolutely unhinged.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
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.
It was withdrawn for sometimes being metabolized into another, toxic and carcenogenic, molecule.
It's a paradox no?
Paracetamol is only the presumed only active metabolite, and that is why paracetamol rapidly replaced phenacetin.
There is a quirk though, phenacetin actually delivers paracetamol to your brain and spine (where it primarily reduces pain) faster than an oral dose of paracetamol.
Similarly IV paracetamol is far more effective that oral paracetamol.
Phenacetin was also considered mildly addictive, and induced a gentle euphoria and then sedation.(We still see sedation after paracetamol in children and the elderly). But general use we don't see these effects in paracetamol, why did phenacetin do this more effectively? Probably the higher peak levels around nerve endings.
These effects are both wanting of an explanation of phenacetin is just paracetamol and directly analegisic.
[0] https://web.archive.org/web/20240721144157/http://www.eviden...
I guess it tracks with personal experience. I find Paracetamol is OK for fevers/generic cold symptoms but absolutely useless for a headache, Ibuprofen is the only thing that shifts them.
Well it's the only thing that shifts them now I'm in a country where I can't buy soluble aspirin and codeine OTC.
What annoys me is that so many people have your experience and are effectively gaslit about the fact it seems to often perform so poorly.
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.
> 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.
Be kind. Don't be snarky. Converse curiously; don't cross-examine. Edit out swipes.
(one of the major problems with paracetamol is that the effective dose is only a few multiples away from the dose which starts to cause liver damage! It is by a long way the most dangerous OTC drug)
Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin.
Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
Here is an example from the Cochrane library
> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.
A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.
The NNT of 22 gives 1/22= 4.5%.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Episodic tension type headache tested with ibuprofen Vs placebo NNT is 14. (Btw that's not great itself) But it's better than paracetamols often quoted figure 20.
Here's why I say it's not great. Why don't you guess some reasonable NNTs for say moderate depression treated with SSRIs, or no relapse in schizophrenia treated with an antipsychotic. Now guess the NNT for a statin to prevent a first heart attack.
SSRI for moderate depression about 10, antipsychotics to prevent schizophrenia relapse over 2 years NNT= 3 (excellent )Statin to prevent a first heart attack 200! (This one always shocks me). Statins have a clear role of course.
[0] https://thennt.com/nnt/ibuprofen-treatment-episodic-tension-...
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.
I wish they dipyrone was sold here, but alas I can only get it when I travel abroad.
For mild stuff I use ibuprofen, if it gets worse, diclofenac works every time.
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.
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.
Usually here in Canada it's available in capsule form which I find less effective.
> 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.
I'm fairly sure that caused some liver damage. I wasn't aware of anything apart from feeling a bit weird.
At the time, I had no idea it was potentially deadly.
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.
I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
Seriously, how can you guys consider this acceptable. I am not of faith but doesn't bible teach to be kind to your fellow men above all? One would expect more adherence to such basic moral rules in such conservative christian society.
Who says that? I don't think anyone sane can believe that US healthcare is "solved".
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
20 not-especially-large tablets
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
---
[1] https://www.tylenol.com/products/arthritis/tylenol-8hr-arthr...
[2] https://www.theraflu.com/products/day-night-flu-relief-max-s...
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
I did toss on the other option, stand alone, at one point so I could get some sleep.
It left the medication I was more comfortable taking as an add-on option if things got bad enough. (This particular medication has much lower risk of overdose, so if I got stupid and took it again there would be no significant additional risk.)
It's ironic, but taking the combined medication with a known higher risk of its own was better than taking the lower risk medication.
One was controlled, higher risk, taken at specific times, while the other was taken in addition, on demand, as required.
Also, loved your TV show back in the day. :-)
I didn't until I had a bulging lower back disc pressing on my sciatic nerve. My leg felt like it was constantly on fire no matter what position I put myself in. In the past I've torn my ACL and had surgery to reconstruct and that pain was like stubbing my toe compared to the back pain. I understood how people become addicted to pain meds after my back situation.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Speaking as someone who is not-infrequently in significant pain, I sincerely hope that you never have to.
I presume your protein intake was adequate and diverse prior to this misadventure....
Ibuprofen is a Nonsteroidal Anti-inflammatory Drug (NSAID) that reduces pain and inflammation, while acetaminophen does not. (Acetaminophen is believed to act mainly in the brain rather than at the site of injury).
Ibuprofen- Fundamentally, if the pain is caused by inflammation, reducing the immune systems response to it can reduce pain, but if the pain is more acute it won't make a dent.
With acetaminophen, taking more isn't a solution in most cases, you need another method to reduce the pain further if it doesn't achieve its goal.
(That's why it's combined with things like codeine, which affects the brain in a different way for an additive effect)
I don’t know about “most cases” but often you don’t want to reduce the pain _further_, you want to reduce the pain _again_. (Having an alternative definitely helps in the meantime.)
edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten
However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/
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.
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.
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.
I don't think you can even do that in the UK.
Yeah we usually have a few packs hanging around, and I get the 'it seems stupid' thing, but sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life. I dunno, I hope that's shown in the evidence anyway. Otherwise it's just pointless like the whole pseudoephedrine song and dance, which has inconvenienced anyone looking for a decongestant while doing sweet FA to the availability of meth.
No, when you visited they were still on the shelf. They only put them behind the counter in 2025.
> sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life
I'm philosophically not for making suicide harder. If someone wants to die, that's their right. And practically, while you might be able to show a stat-sig decrease in paracetamol poisoning, I'd expect the suicides to largely just move to other methods.
tl;dr: Yes
Paraphrasing from [0], after September 1998 when the restriction was introduced, "The annual number of deaths from paracetamol poisoning decreased by 21% [...] the number from salicylates decreased by 48% [...] Liver transplant rates after paracetamol poisoning decreased by 66% [...] The rate of non-fatal self poisoning with paracetamol in any form decreased by 11%"
See also [1]: "in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC31616/
[1] https://www.psych.ox.ac.uk/research/research-groups/csr/rese...
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]
Alcohol and Acetominophen/paracetamol should not be mixed.
When alcohol enters the picture, it increases the activity of CYP2E1, so the body produces more of the NAPQI toxin. Alcohol also decreases glutathione production, the body’s natural defense mechanism, meaning NAPQI is more likely to build up in the liver in dangerous concentrations.
Sorry, crappy link. If you don't like it, it is easy to search for a better one.
Your crappy source is vague in what consumption pattern constitutes a risk and actually cites a better source that supports the idea that acute alcohol consumption reduces paracetamol toxicity. https://www.biorxiv.org/content/10.1101/2020.07.07.191916v1....
That's a mathematical model, but this relationship between the two is what I was taught in medical school and it is still supported by the science. There's plenty of other sources, I just picked that one because your article cites it. Just search for "paracetamol ethanol" on Google Scholar.
Also applies to most similar phrases ending in -proof. Should be eye-opening.
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.
Took me 3 months, out of 2 i wasn't able to sit. Luckily I could walk and that give me great relief. So walked for hours.
Keeping the habit, will mostly being coding from my phone & walking from now on.
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.
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.
"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?"
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.
I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.
A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.
From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...
I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.
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.
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.
And when you want to be gentle, you alternate between them.
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.
In general, taking a lower dose than recommended can cause problems, but aside from antibiotics, the problems are probably going to be from insufficiently treating the underlying condition, rather than the medication itself. Most OTC drugs give a single recommended dosage for all adults, so some people will necessarily get a lower "effective" dose than others (eg. a 200 lb man compared to a 90 lb woman).
> Specifically, the two mentioned in the article. [...] but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
With the caveat that I'm not a doctor, you should be fine: the only effect of acetaminophen is pain suppression, so if the pain is tolerable, then you should be fine. Ibuprofen has some anti-inflammatory effects that could be important here, but realistically, if the anti-inflammatory effects are the primary reason for the prescription, then your doctor is more likely to prescribe naproxen or celecoxib.
But if this ever comes up for you again, probably the best solution would be to tell your doctor/pharmacist "I have a high pain tolerance, would it be okay if I take less?", since in my experience, medical practitioners are generally pretty happy to hear when you want to take less drugs.
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'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.
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.