Were all OTC pain killer created equal?

nesf

Obviously not but I'm curious. I've heard (from doctors) such statements as ibuprofin works better for sinus/ear pain and so on and am curious as to whether there's been much research in this area. I've often heard on here and elsewhere that ibuprofin isn't really that much more effective overall as a painkiller or anti-pyretic (sp?) than paracetamol and most of its reputation was earned through marketing rather than through studies. How true is this?

angeldelight

I don't have any studies or references to hand but in general ibuprofen is better for pain caused by some kind of inflammation as it has three aspects to it (a) analgesic (b) anti-inflammatory (c) anti-pyretic while paracetamol only has (a) and (c). So if, e.g. you had pulled a muscle in your back ibuprofen would be better to reduce inflammation. The thing about ibuprofen is that one dose should be enough to start having an analgesic effect but you need to take it regularly for the anti-inflammatory effect so 3/4 doses in before that starts to take effect

SomeDose

angeldelight wrote: »

I don't have any studies or references to hand but in general ibuprofen is better for pain caused by some kind of inflammation as it has three aspects to it (a) analgesic (b) anti-inflammatory (c) anti-pyretic while paracetamol only has (a) and (b)

Surely you meant (a) and (c)..!

I've got an article somewhere on the genesis of ibuprofen and subsequent NSAIDs, I'll try to dig it out....

angeldelight

SomeDose wrote: »

Surely you meant (a) and (c)..!

I've got an article somewhere on the genesis of ibuprofen and subsequent NSAIDs, I'll try to dig it out....

Oops I did indeed mean a and c... next time I should type it out and avoid shortcuts

drzhivago

nesf wrote: »

Obviously not but I'm curious. I've heard (from doctors) such statements as ibuprofin works better for sinus/ear pain and so on and am curious as to whether there's been much research in this area. I've often heard on here and elsewhere that ibuprofin isn't really that much more effective overall as a painkiller or anti-pyretic (sp?) than paracetamol and most of its reputation was earned through marketing rather than through studies. How true is this?

Forgive the simplification but there are a number of charts which will show the relative pain killing strengths of

Aspirin
Paracetomol
Codeine
Tramadol
Morphine and their associated derivatives
Various Anti-inflammatories and their derivatives

These are generic studies when you take them all back to the individual its a bit like kids who drink for the first time
Heineken is stronger then carlsberg (so they think) so they feel they get drunk quicker

Tell someone they are getting a strong pain killer and they will believe more in the drug

Even very strong pain killers may have little effect on some people

For some it takes a time to figure out which one of the multiple varieties of pain killers or anti-inflammatories works stronger for them

Is Tylenenol stronger than panadol
Ask people on the street many will say yes, read the ingredients, exactly the same

tallaght01

SomeDose wrote: »

Surely you meant (a) and (c)..!

I've got an article somewhere on the genesis of ibuprofen and subsequent NSAIDs, I'll try to dig it out....

there's not a very good evidence base for paracetamol and pyrexia (in kids anyway).

It makes them feel less miserable because it presumably helps with their sore ear/myalgia or whatever. But its effects on temp are probably exaggerated.

nesf

tallaght01 wrote: »

there's not a very good evidence base for paracetamol and pyrexia (in kids anyway).

It makes them feel less miserable because it presumably helps with their sore ear/myalgia or whatever. But its effects on temp are probably exaggerated.

So would you recommend ibuprofin for young children as the "go-to" fever reliever? (interested parent question, ignore if it's too close to the medical advice question but I feel it's general enough in nature to be ok).

nesf

drzhivago wrote: »

Forgive the simplification but there are a number of charts which will show the relative pain killing strengths of

Aspirin
Paracetomol
Codeine
Tramadol
Morphine and their associated derivatives
Various Anti-inflammatories and their derivatives

These are generic studies when you take them all back to the individual its a bit like kids who drink for the first time
Heineken is stronger then carlsberg (so they think) so they feel they get drunk quicker

Tell someone they are getting a strong pain killer and they will believe more in the drug

Even very strong pain killers may have little effect on some people

For some it takes a time to figure out which one of the multiple varieties of pain killers or anti-inflammatories works stronger for them

Is Tylenenol stronger than panadol
Ask people on the street many will say yes, read the ingredients, exactly the same

I was more getting at which different drugs work with better with different kinds of pain or other things rather than general pain relief effects (i.e. ibuprofin > paracetamol for pleurisy pain I imagine because of the anti-inflammatory effect but as a non-medic I don't want to speculate too much about this stuff). I'm tempted to ignore codeine and focus more on paracetamol vs aspirin vs ibuprofin since they're what's in most people medical toolbox at home.

You're completely correct about individual effect, they could start putting sugar pills into paracetamol boxes and many/most of us wouldn't notice next time we had a minor headache.

tallaght01

I don't give any meds for fever. If the kiddy is distressed with it, ill give pain relief, rather than fever relief. I usually start with paracetamol, and move my way up. But it varies depending on the situation sometimes.

But lots of kids are overdosed on meds anyway.

I'd love to do random paracetamol levels on kids coming to A+E as an experiment.

tallaght01

In terms of which pain killers work best with different types of pain...I feel they work synergistically. Ibuprofen works better on a background of paracetamol. I do think ant-inflammatories work best for ear pain, and sometimes go straight to them. Bony mets respond very well to anti-inflammatories too, in many cases.

But usually I climb the analgesic ladder.

nesf

tallaght01 wrote: »

I don't give any meds for fever. If the kiddy is distressed with it, ill give pain relief, rather than fever relief. I usually start with paracetamol, and move my way up. But it varies depending on the situation sometimes.

You'd be happy to leave a kid at a temp of 102/39 without anything? Genuinely curious, most of the advice we've got has been to give them something to bring down fever.

tallaght01 wrote: »

I'd love to do random paracetamol levels on kids coming to A+E as an experiment.

It would be interesting alright. Do you think people are giving more that the guidelines or doling it out twice or three times a week on average?

I can definitely guarantee you we gave our first lad Calpol on many occasions when he didn't really need it when he was under 1 year. New parents, clueless in so many ways with a healthy dose of over-caution and fear of not doing the right thing.

tallaght01

if a kid is happy with a fever, I give them nothing, except in some isolated cases where I want to reduce their metabolic rate. But generally, most paediatricians hate the idea of treating fevers in healthy kids. Plus kids fevers go up an down on their own. Calpol isn't usually what brings it down. It just makes them happier.

I think parents give the wrong doses lots of times, or give it for everything. They give it of the kid is a little grizzly, or won't sleep. I reckon they're giving some pretty high doses when they're sick, too.

me_right_one

TBH I've never found any OTC painkiller any good. Paracetemol actually GIVES me a headache

metrovelvet

Calpol doesnt bring down fever?

Then why did the doctor tell me to give Calpol when my 2 year old had a 39.7 fever?

The fever went down on its own and it was just a coincidene that I had given him Calpol before?

nesf

tallaght01 wrote: »

if a kid is happy with a fever, I give them nothing, except in some isolated cases where I want to reduce their metabolic rate. But generally, most paediatricians hate the idea of treating fevers in healthy kids. Plus kids fevers go up an down on their own. Calpol isn't usually what brings it down. It just makes them happier.

I think parents give the wrong doses lots of times, or give it for everything. They give it of the kid is a little grizzly, or won't sleep. I reckon they're giving some pretty high doses when they're sick, too.

Very interesting stuff, cheers for taking the time to talk about it, it's fascinating to get a paed's opinion on this stuff. Is ibuprofin any more effective at bringing down fevers? I ask mainly because our lad had some kind of virus recently and his temperature off ibuprofin was 39-40/102-103, and we did dose him with ibuprofin and paracetamol to keep it low as that was what we'd been taught to do. Should we switch to only giving him drugs if he's uncomfortable/not dealing with the fever well?

metrovelvet

^ I know you asked Tallaght this but I was told by two different doctors that if the fever reaches 40 you risk febrile convulsions.

nesf

metrovelvet wrote: »

^ I know you asked Tallaght this but I was told by two different doctors that if the fever reaches 40 you risk febrile convulsions.

It depends on the age of the kid, from what I remember. Under 12 months fevers are a lot more serious for children iirc. Our 3 year old was running around with a fever of 40 and it didn't seem to be bothering him. We only gave him ibuprofin and paracetamol because we believed it was right to bring his fever down.

tallaght01

There's no good evidence that the degree of temperature is related to the chances of seizure. But parents should do what they feel is right for their kid. I have my own way of doing things that's tempered by knowing what's wrong with the kid, an having the benefit of a physical examination. These decisions are much easier for me.

nesf

tallaght01 wrote: »

I have my own way of doing things that's tempered by knowing what's wrong with the kid, an having the benefit of a physical examination. These decisions are much easier for me.

There's nothing like experience to help you tell a sick person from a normal person, as every parent learns after the first time their child gets properly sick.

Thanks for taking the time to answer these questions, I appreciate that we're very close to the line of what's acceptable on this forum with regards advice.

JuliusCaesar

I never gave my youngster anything for a fever, unless it was hitting 40. I figured that the fever is a response to infection which was generally adaptive in that the raised temp killed off the virus/bacteria/whatever. But I did keep a very close eye on him!