The father of the famous German scientist and chemist Felix Hoffmann was afflicted with rheumatism, so Hoffmann decided to put all his efforts into relieving his father’s pain. In 1897, he was able to dazzle the world by inventing the first analgesic known to mankind, which was “aspirin,” for which the Bayer company he worked for won the Nobel Prize in Chemistry in 1905.
The quest to relieve patients’ pain did not end there, as coincidence led two German scientists to another pain-relieving drug that is stronger than aspirin. At first, the two doctors noticed that the substance “naphthalene” used to expel worms caused a patient’s temperature to drop dramatically, but they also noticed some negative effects of the drug.
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In 1893, chemist Joseph von Mering decided to revive the experiment and modify the substance to produce paracetamol, but he mistakenly believed that the new compound caused blue discoloration of the skin, which meant a lack of oxygen in the blood. Years later, scientists Bernard Brody and Julius Axelrod proved that paracetamol is completely safe for the blood, and is responsible for relieving pain. Then it appeared under the name Panadol in 1956 to become the safest analgesic for the stomach.
Aspirin remained a popular treatment in the 1950s, but some negative effects began to appear, including ulcers and stomach bleeding.
British pharmacist Stuart Adams decided to begin the journey of searching for an alternative. He formed a research team and worked over the years to test more than 600 chemical compounds, but all of them failed.
In 1961, Adams was suffering from severe headaches, and he decided to be the first to try a new compound that had not yet been tested on humans, ibuprofen. Suddenly, the headache completely disappeared and no side effects occurred.
A year later, the compound received a patent, and was put on the market in 1969, as the most important line of defense against inflammation and joint pain. To this day, no home is without one of these two compounds: paracetamol and ibuprofen as medications to relieve emergency pain, but which pain can be relieved with each of them? Ibuprofen belongs to the group of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs).
Dr. Noura Amr Agiz, teacher of anesthesia and pain therapy at Cairo University Faculty of Medicine, says that these drugs work to inhibit enzymes called “cyclooxygenase” (COX), which is responsible for producing chemicals secreted by the body and plays an essential role in inflammation, the feeling of pain, and high temperature.
As for paracetamol, she explained to Al Jazeera Net that it works in a different way: “Although it effectively relieves pain and reduces fever, it does not have an anti-inflammatory effect to the same degree as ibuprofen, and therefore its use is different in some pathological cases.”
When is ibuprofen the best option?
Ibuprofen is known for its ability to treat pain accompanied by inflammation. Therefore, doctors prefer it in cases such as:
- Joint pain and rheumatism.
- Sports injuries and sprains.
- Muscle pain caused by inflammation.
- Toothache accompanied by swollen gums.
- Some types of menstrual pain.
In these cases, the effect of the medication is not only limited to relieving pain, but it also helps in reducing the inflammatory process behind the symptoms. When is paracetamol enough?
Paracetamol is a good choice for many mild to moderate pain, such as:
- Headache. Colds and influenza. Fever in children and adults. Minor pain after vaccinations.
- Some muscle pain not accompanied by obvious inflammation.
- It is also often preferred by people who suffer from stomach problems or have a history of stomach ulcers or gastrointestinal bleeding.
Who heals the “House of Disease”?
Side effects on the digestive system are among the most prominent problems associated with ibuprofen and other non-steroidal anti-inflammatory drugs. As Dr. Noura Ajeez explains, repeated use or high doses can lead to: stomach irritation, stomach ulcers, gastrointestinal bleeding, and it may even lead to perforation of the stomach or intestines.
“The risk of these complications increases in people over the age of 60, who have a previous history of stomach ulcers, or who take blood-thinning or cortisone medications,” says Dr. Noura.
In contrast, paracetamol does not usually affect the stomach lining, and does not increase the risk of bleeding, which makes it safer in this regard.
What about the kidneys?
A large population-based study published in the Clinical Kidney Journal suggests that use of nonsteroidal anti-inflammatory drugs (NSAIDs) in older adults was associated with an increased risk of acute kidney injury (AKI) during the first 30 days of use compared to no use.
For this reason, Dr. Noura Al-Ageez advises caution when using ibuprofen for long periods or in high doses. “This must be done under the supervision of a doctor to adjust the dose and duration of taking the analgesic.”
She continues, “Paracetamol is considered to have less effect on the kidneys when used in recommended doses, but it is not completely free of risks in cases of excessive doses.”
Liver: the main weak point of paracetamol
If the stomach and kidneys are the biggest concern with ibuprofen, the liver is the organ most at risk from uncontrolled intake of paracetamol.
Excessive use of paracetamol is one of the most common causes of drug-related acute liver failure, according to a recent review published in 2023 in the journal Expert Opinion on Drug Safety. Even therapeutic doses may become dangerous in some people who suffer from liver disease, severe malnutrition, or consume large amounts of alcohol.
The problem is that many cold and flu medications also contain paracetamol, which may lead to taking higher than permissible doses without the patient noticing.
Asthma and the elderly
Ibuprofen may in some cases trigger asthma attacks in people sensitive to NSAIDs. The elderly are also more susceptible to its digestive and renal complications.
As for paracetamol, it is often considered safer for the elderly when used in accordance with the recommended doses, although it is necessary to pay attention to liver function.
Should I consult a doctor?
Dr. Noura believes that taking an analgesic without consulting a doctor is permissible in emergency and temporary cases and depends on the patient’s medical history. She says: “In some cases, the doctor may decide, and under medical supervision, that paracetamol and ibuprofen can be used together or alternately to achieve better control of pain or fever, especially after some surgical operations or in children with high fevers that are difficult to control.”
But this does not mean that combining them is suitable for everyone, as age, health condition, and other medications that the patient is taking must be taken into account.
Which is better?
There is no one-size-fits-all answer. The choice of analgesic depends on the nature of the pain and the patient’s health condition. If the pain is accompanied by obvious inflammation, such as joint pain or swelling, ibuprofen may be more effective.
If the goal is to reduce fever or treat a headache or minor pain, and the patient suffers from stomach problems or is taking blood thinners, paracetamol may be the safest option.
In the end, although these two medications are easy to obtain from pharmacies, treating them as “simple” medications may be misleading. Incorrect use or overdose can turn a common analgesic into a cause of serious complications affecting the stomach, kidneys, or liver.
Therefore, the golden rule remains to use the lowest effective dose for the shortest possible period, while consulting a doctor or pharmacist when there are chronic diseases or the need to take painkillers repeatedly.
