I get what you're saying, but ibuprofen and acetaminophen save lives. The problem is the western (American?) tendency to self-medicate and to over medicate with really potent stuff. That shouldn't be as normal as it is.
Not necessarily.
Fevers can cause seizures and they can have detrimental effects in paediatric patients. For the bulk of the general population, these painkillers/anti inflammatories are simply symptom relief.
For those talking about hyperthermia killing, yes but in almost all those cases the cause is not an infection.
In fact, I would say that paracetamol kills a hell of a lot more patients than it actually ‘saves’.
A study I have taken to heart is that permissive hyperthermia (up to 40 deg c) in ICU patients has a greater survival than those where fever is treated aggressively.
Physiologically, this resonates because high temperatures activate the immune system and raised temperatures are non-optimal for bacterial proliferation; so the immune system is primed by fever; suppressing it can dull immune system response.
In fact, malaria was used as a treatment for syphillis in the early parts of the 20th century because high temperatures kill spirochetes. There are also a decent number of case reports of cancers going into remission following fever.
However in my quick mobile google then I could only see the following study that demonstrated no advantage for either control of permissive hyperthermia group in ICU patients; so perhaps I was relying on a study that has been superceeded.
Fever can indeed kill. Raise the body temp a few degrees, no matter the cause, and things start going wrong very quickly. Google hyperthermia.
In fact, i cannot think of any disease that literally kills. Even with the big stuff like cancer or aids, it is always the symptoms that get you. They damage body systems and the decline of those systems (aka symptoms) eventually causes the cardiac arrest or internal bleeds that shut off nutrients to the brain. Those symptoms are just as lethal no matter thier cause. A massive fever that stops normal body chemistry, whether caused by flu or ebola, will kill you just the same.
Not a doctor: Isn’t fever (objectively, it seems) defined as a rise in body temperature? From what I’ve learned about protein denaturalization in high school, that doesn’t sound good if excessive.
And an acetaminophen tablet is a painkiller. While your statement is in fact true, ibuprofen is still a better choice for a fever. The latter is also generally considered a safer alternative, especially in long-term use — even though alternating the two would be ideal.
Acetaminophen is actually a pretty dangerous drug that is pretty easy to overdose on. It’s been said if it were discovered today it would be a prescription drug.
On top of that numerous recent studies have shown many potential problems.
> Heavy use of acetaminophen is associated with kidney disease and bleeding in the digestive tract, the paper reports. The medication also has been linked to increased risk of heart attack, stroke and high blood pressure, the study authors noted.
> One cited study even showed that overuse of acetaminophen can increase a person's risk of early death as much as 60 percent, the study authors found.
This. Just had friends visiting. Their teenage son had had his wisdom tooth pulled last week. Dentist had then given him (as a standard practice?) prescription for Ibuprofen (800mg tabs?) AND some opioid based pain killer! Needless to say, latter they said went directly to trash after they realized what it contained and for ibuprofen they halved the dosage.
To me and his parents this was pain management gone way over dose! But we’re not medical experts and should not be doing clinical decisions since at one end of this rabbit hole you will find anti-vaccination and other nut jobs.
I just had wisdom teeth extraction a few weeks back. I was given 800mg Ibuprofen and Norco. The pain was bad enough to wake me up at night when the meds wore off — and I did take both. Oral surgery is no joke. It took me about 8 days to taper to 400mg Ibuprofen.
These doctors don’t just give pills out randomly, they do it for a reason based on evidence and science. A side note is that my pharmacist made it very clear to only use the painkillers as necessary. You should always consult the doctor and pharmacist after major surgery to clarify these things if needed.
The pain varies wildly from person to person. A friend of mine was out of order for two weeks after having a single tooth removed. I had all 4 removed and recovered in a few days and without much painkillers.
IMHO the doctors should prescribe less at first and see if it would be enough, but I also get that they are overcrowded and the same patient coming back for just more painkillers might be a little too much.
One thing is not to put medicines, OTC or not, into the trash. They are nasty stuff to have in the dump.
As for the drugs: don’t take analegics if you don’t need to; do if you can’t tolerate the pain. Everybody has a different level of pain and tolerance and I bet the prescription said something along the lines of “...as needed”
As for other prescriptions, do your research; odds are you do need it but not always.
What to do? IMO: follow the doctor's/pharmacist's instructions precisely. In my case we were instructed to only break out the opidoid in the event of severe pain (has never happened to me but I guess it's possible), and there were quite specific instructions regarding it. If you don't end up needing it, dispose of it.
Exactly this. Removing wisdom teeth in particular seems to affect everyone in totally different ways that can't easily be predicted, so doctors over-prescribe and give strict only-as-needed instructions.
I had a similar experience. My oral surgeon, who did a great job, highly recommended I fill the painkiller prescription and take it. He recommended this several times throughout the process, before and once before I left, as did the nurses (?) at the counter, as I expressed some concerns about it.
I finally caved and then took a half dose right after the extraction because I was fearing terrible pain, especially since the surgeon said mine was a fairly difficult job that would probably end up causing more pain than is typical.
The half dose of painkiller made me extremely nauseous, and so I decided to just try the 800mg of ibuprofen, and it did the job perfectly. I did feel a little sore and stiff, but never in pain unless I waited too long for another ibuprofen dose. It was the same for my girlfriend, who was also prescribed the pain killer but didn't take it because she didn't feel she needed it either.
The pain killer being prescribed didn't bother me per se, and neither did the recommendation, and I don't think anything nefarious was going on. Also, everyone's body is different. But given the side effects, and potential side effects, I just felt that even a simple "we recommend you get this prescription filled, but please see how the ibuprofen works first, and only take the pain killer if you can't handle the pain on ibuprofen alone" would have been a better way to handle it.
There's probably nothing wrong with taking 800mg of ibuprofen at least for a short period of time. Ibuprofen can have some negative effects from long-term use though.
Regarding opioid based pain-killers... for all the negative attention they get, they're also usually fine for most people - when used as directed and, again, for a short-period of time.
Not everybody who takes a few Oxycodone tablets winds up addicted and then reduced to using heroin to get their fix.
This is why I hate reading these type of posts on HN. Especially like in this case where there's still a lot to be researched on and to drawn conclusions from, and the outlook isn't positive.
My recommendation is to go and talk to your doctor and confront him or her with this "finding".
Also, most importantly, this "finding" has been out for almost a year now. I wonder what's the more recent development on it.
Move to Europe where we don't get as many drugs prescribed? I think the only time you get opioids is after major surgery. Personally I don't know anybody who had to take them.
No opioids after my wisdom teeth extraction would have resulted in potentially suicide. The pain was unbearable, and 3-4 days of hydrocodone was absolutely proscribed.
There is nothing wrong with opiates being used for acute pain relief. They are a modern miracle when put to such uses.
The problem comes when you start using them for long-term pain relief - a use-case in which they are neither appropriate or effective.
A typical 2-3 day prescription after major dental (or other) work is not remotely a problem, and I really have no idea why this is where the focus is. It's always been long-term abuse as the actual problem - the weird overreaction over a few days use for acute pain is utterly absurd and only hurts people in some bizzare way for folks to feel they are "helping" fix the abuse problem.
Definitely varies by individual, and by the nature of the situation. My personal experience, as somebody who considers himself to have a pretty high threshold of pain tolerance, is that I never needed any of the Vicodin I was prescribed after wisdom tooth removal... but I can't imagine how I would have survived without Oxycodone in the first week after rotator cuff surgery.
Co-codamol (codeine and paracetamol) is widely prescribed IME in the UK, eg for back pain, muscle pain.
I had Oramorph for abdominal pain (in hospital, no surgery thankfully). The condition may have been caused by medium term use of Ibuprofen (in my non-medical opinion).
I doubt anyone is interested in protecting ibuprofen from a commercial point of view. Generic ibuprofen is extremely cheap; if anything the industry would probably like people to stop using it so that they could sell novel NSAIDs.
OTOH acetaminophen is known to be toxic; is there an alternative here for non narcotic inflammation, fever, and pain relief that is shown NOT to have tradeoffs for use?
Acetaminophen/paracetamol is really only toxic in higher doses due to its metabolism, as only the intermediate metabolite NAPQI is toxic, but that cannot build up in low doses.
Still, it seems just as easy to have too much of a dose or acetaminophen in a single day as it is to use ibuprofen continually for an extended period of time.
I just started using CBD, it’s possible it’s just placebo, but I feel no more pain in my joints in the Am, am more relaxed, less anxious, more agreeable and more aware of my body.
Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose[1] (this is one of the reasons you are told not to drink alcohol when taking paracetamol -- if your liver is struggling to process alcohol you're more susceptible to liver failure).
In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2]. And in 2006, [3] found it was the most commonly used compound for intentional overdosing (i.e. suicide by overdose).
But of course, this depends on taking a very high dose -- paracetamol isn't dangerous in moderate doses.
> In fact, paracetamol poisoning is the primary cause of death in overdoses (in the US, UK, Australia and New Zealand)[2].
No, it isn't, and for the people who die from paracetamol it's an intentional overdose, it's very rarely an accidental overdose.
In the US about 500 people die each year from acetaminophen overdose per year, compared to over 70,000 from opioids.
Your link number 3 is talking about compounds containing paracetamol. For example, this includes coproxamol. Anyone overdosing on coproxamol was dying from the opioid (dextropropoxyphene), not from the paracetamol.
I can't cite a source, but I recall being told when I was prescribed a few days of vicodin+acetaminophen after an appendectomy that acetaminophen is (often? sometimes? always?) combined with some potentially-addictive painkillers to limit the extent to which they can be abused without the user needing treatment for liver issues.
This doesn't really undercut anything you say, but if I was given accurate information I assume a subset of those acetaminophen OD deaths are from people abusing painkillers it's combined with. I haven't looked into it, but I assume this is also a partial explanation of why OTC cold medications with Dextromethorphan in them tend to be combined with a relatively high dose of acetaminophen. I would guess there are other good examples of abusable pharmaceuticals combined with acetaminophen.
There's a little bit of truth to this--historically, lower doses of hydrocodone and oxycodone mixed with acetaminophen were a lower drug schedule in the US, allowing for less stringent requirements on security during production and transportation. Presumably, this was because the DEA thought there was less potential for abuse in the combinations drugs.
However, there's a more important medical reason: acetaminophen accentuates the analgesic affects of opioids, although the mechanism for this is not clearly understood. This makes acetaminophen-enhanced opioids more effective drugs.
Opioid abuse has become so rampant, though, that we're moving away from prescribing acetaminophen-enhanced opioids like Vicodin and Percocet to try to stop them entering the recreational drug market. As opioid use has increased, so has the number of liver toxicity deaths due to the acetamiophen in some prescription opioid drugs.
This was mentioned in the Wikipedia article about paracetamol poisoning (though the reason paracetamol is added to opiod painkillers is because apparently the combination works better than either drug separately).
But the original point was about whether paracetamol is toxic, not how often people overdose on Panadol (though that does happen in suicides). And the answer is "yes, but not in the dosages you'd normally see".
> Paracetamol (or acetaminophen) can cause liver failure if you take too high a dose
Sure, and drinking too much water causes hypernutremia that can also kill you. Toxicity is always dose dependent, so the initial unqualified claim seemed to imply toxicity at normal dosages.
Botulinum toxin (botox) doesn't kill most people in the standard dosage, but it is obviously toxic (it's in the name).
Paracetamol poisoning is fairly common, hypernutremia isn't. Don't get me wrong, I disagree with the original statement that paracetamol is toxic (with the implication that this is a reason not to use it in normal dosages). But it's definitely not harmless.
I agree it's not harmless, but strictly speaking this kind of phrase is meaningless because nothing is intrinsically harmless. Dosage dictates all harm.
Probably the closest to harmless you can get are the inert gasses, and even then they can cause harm by displacing oxygen to deadly levels.
No tradeoffs? I don't think such a thing exists. Aspirin kills people every year. The only pain reliever I know of that has never killed anyone is cannabis. I don't think it does much for fever though?
Where did I say anything about smoking? And I also didn't say cannabis has no tradeoffs either. But it won't kill you. That's a pretty strong pro in my book if you are looking for occasional pain relief.
The social conservatism about cannabis was created and stoked by propaganda and laws created in large part due to industrial lobbying, if you look back a generation or two.
I looked for studies supporting your statement. The evidence is conflicting, and there appears to be no conclusive evidence one way or the other, although some people certainly are fond of repeating this as if it's fact.
>resulted in the clinical condition named "compensated hypogonadism," a condition prevalent among elderly men and associated with reproductive and physical disorders. In the men, luteinizing hormone (LH) and ibuprofen plasma levels were positively correlated, and the testosterone/LH ratio decreased.
Fuck that.
I wonder what I should give my kids when they have fevers though
>I wonder what I should give my kids when they have fevers though
You don't have to give them anything. Ibuprofen doesn't make the underlying infection causing the fever go away any quicker, it just alleviates the symptoms. It's a trade off between reducing short-term suffering and risking long-term defects. Personally my parents never gave me painkillers for fever and I'm grateful for it: fever pain is just a temporary feeling, but some of the uncommon side effects of painkillers are much longer-lasting.
*Edit: To whomever downvoted, I'm curious what part of what I said you disagree with.
I didn't downvote you, but you seem to lack experience/knowledge on the topic if you think it's only a painkiller.
Ibuprofen's main use is to help to keep the body temperature in check. When your body temperature goes too high you can lose consciousness and even die. I had a very high fever once and didn't want to take any medicine until I started to lose consciousness and I almost fell while waiting in a line in pharmacy. I was able to go through it only because I was adult. Children are more fragile. Fever is the reason people died so much before discovery of antibiotics.
You are right that it alleviates the symptoms, and it's actually better not to use it when the temperature is moderate because high temp kills some germs. But if it goes too high, you have to stop it before it's too late.
>Fever is the reason people died so much before discovery of antibiotics.
I thought bacterial infections were the response were the reason people died before antibiotics. Fever is the body's response to infection, a primitive means of fighting it. If somebody has a serious infection and you give them anti-fever medication but no antibiotics, they're still at serious risk of death even if their fever goes away.
"The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen."
"In 1997, these data led to a large, randomized, placebo-controlled trial of ibuprofen in 455 patients with sepsis, a life-threatening infectious condition. In this study, ibuprofen failed to prevent the worsening of sepsis and failed to decrease the risk of death."
So there's no evidence that such drugs actually stop fever "before it gets too late" in adults, as they don't reduce risk of death. I had wrongly assumed the same applies to children.
Yep, but if death was due to the combined effects of both bacterial infection and fever, we'd expect to see a reduction in mortality when fever was treated compared to when it was untreated, which the linked study didn't find.
Ice bath has really short-term effect. If your body temp is really high, ice bath can take it down for 30-40 minutes and then it's back up. Ibuprofen takes it down for 6 hours.
True, but children are not that fragile. High (above 103/104) should be brought down, febrile seizures are bad but lots of parents hit ibuprofen/paracetamol when the kid is showing 99F.
My guess is the down vote comes from someone thinking your comment sounds like you don't have any children or know what you are talking about. You don't give ibuprofen for pain during a fever, though doctors will say it can help because often times the source of the fever will cause pain like an ear infection or strep throat, you give it to reduce the temperature. There is a serious risk of seizure in children if you let fevers run high. So to say you don't have to give them anything is certainly not true in many cases and in fact could be life threatening to just ignore. That would be my guess to the down vote. I have multiple kids and never has the thought in my mind been I will give them analgesic for the pain of their illness. It is about the temp 100% of the time. I do not like to take drugs nor give them to my children if avoided but certain things you must treat. Fever is one.
"The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen."
"In 1997, these data led to a large, randomized, placebo-controlled trial of ibuprofen in 455 patients with sepsis, a life-threatening infectious condition. In this study, ibuprofen failed to prevent the worsening of sepsis and failed to decrease the risk of death."
The science doesn't seem to support the notion that reducing fever will reduce the risk of fatality in the general case. I had assumed the same thing also applied to children, as before this thread I'd never heard of children getting seizures from fever (at least not from any of the children/parents I knew growing up in rural Australia).
Why do you pose a ridiculous question, implying the parent commenter is a bad person who doesn't love their children or whatever?
Do you give your children general anesthesia when they are in pain? E.g. they've fallen and bummed their knee or something?
Why not, since it would be the ultimate pain-killer? Because it's both dangerous and unnecessary.
The parent has the same reasoning for other unneeded and dangerous drugs.
Why can discuss whether they're really as unneeded and dangerous as the author implies, but that's another question, not loaded with "why don't you love your children" implications...
Painkillers are not side effect free; if the pain is something minor, like a bruised knee or normal headache, it's not unreasonable to decide that experiencing the pain is a better choice than risking the side effects of a drug, which in uncommon cases can be much more severe and long term. It's not as clear cut as "helping" vs not helping, as unfortunately we don't yet have any side effect free painkillers.
Also, the pain sometimes keep activity low which may help with healing. If I give my kid something pain relieving he'll be up and bouncing around and could hurt himself more.
I meant in the sense I don't give pain killer for pain during a fever but I give it during a fever to help with the temperature. It is not to take away the pain of a fever but the temperature but often times there is something painful causing the fever so it helps. Now as for giving my kids analgesic I do give them Acetaminophen and Ibuprofen occasionally when they really need it. I encourage things like rest in a dark room and more fluids first but you get to know as a parent when they are really not well and when they just need to take a break from screen time or activity or take something like tylenol. Medicine is not my go to but I use it accordingly.
I am sure there are nuances to your statement that get lost in the short text so I assume that you don't mean it quite as hyperbolic as it comes across but my immediate reaction to that sentence is: you can't protect your child from pain forever -- physical or emotional. How will they learn to handle it if they aren't exposed to it gradually?
Your parents probably aren't doctors. The issue isn't cut and clean... To a point a moderate fever usually helps your immune system (the response exists for a reason), but anything other than a moderate fever can be a lot more dangerous than long term issues stemming from sporadic usage of antipyretics.
Replying to my own comment as it's too late to edit, I was basing my assumptions on studies showing fever reducing drugs have no positive effect on mortality in adults, like described in https://www.google.com/amp/s/www.nytimes.com/2018/05/11/well..., but was unaware that children face separate risks from high fever that can make such drugs more vital. So my comment is bad advice.
Rapid rise in temperature in infants, toddlers, and young children can cause febrile seizure. Given the trade-offs, we generally choose to medicate our child when his temperature passes ~102 and it's on a rapid uptrend.
yes, but is this sampling a good idea? Have you tried measuring temperatures periodically when the child appears well? What is the variation then? How do you know that the device is telling you something meaningful? Is the child getting flustered and hotter because of the attention?
Exactly this. It just works on the symptoms and children tolerate fevers fine as long as it is not too high (above 103F). But you have to endure a lot of crap from everyone breathing down your neck about how you are ignoring the child and are a cruel parent.
These kind of sentiments really scare and provokes me. Telling anyone that they shouldn't alleviate kids fever and/or pain is absolutely revolting to me.
I didn't say that, I said it's a trade-off. Taking them reduces pain and the risk of certain complications, but increases the risk of other complications (side effects). According to https://www.consumerreports.org/prescription-drugs/too-many-..., "The amount of harm stemming from inappropriate prescription medication is staggering. Almost 1.3 million people went to U.S. emergency rooms due to adverse drug effects in 2014, and about 124,000 died from those events." So even if a medicine is side effect free when used as prescribed, there are still risks if it's accidentally misused, and painkillers are not side-effect free even when used as prescribed.
Thought effect: if you had the option to eliminate a kid's pain with an 0.01% chance of causing a lasting defect, would you do it? Not everybody would; different people have different time preferences.
Ah, good catch, I didn't notice that part. Here's a more relevant link, evidence for the trade-offs of OTC painkillers: https://www.sciencedirect.com/science/article/pii/S014067360... . Seems there's evidence of a link between use of paracetamol in early childhood and developing asthma.
Fever is likely a mechanism that the body exercises to fight infections, just the way diarrhea is probably a way for the body to flush out vira and bacteria quickly. In both cases, excess can be dangerous but that doesn't mean they should be stopped per default.
Would you also give your kid anti-diarrhea and let the disease spread in order to stop the immediate unpleasantness?
What if the fever is actually the body’s way of killing the infection? You’re saying it’s scary that someone would want to prioritize recovery from the root cause rather than prolonging the root cause in favor of relief of mild symptoms?
That’s the more shocking belief from my perspective.
> I wonder what I should give my kids when they have fevers though
You can use any drug containing Paracetamol (Tylenol, Panadol). It isn't that effective, but it works and as far as we know it's perfectly safe if you adhere to dosage recommendations.
You can still give them aspirin and/or ibuprofen. People have done it for over half a century, and the sky hasn't fallen.
How much/often were those people taking ibuprofen to have those effects? And how worse were they than the baseline? From what I see, they took 3 times a day for 2-3 weeks (not just to pass a small fever), and they were older men to begin with (e.g. already on a downfall for testosterone).
High fever is not good. While I think you should be restrictive with medications. There's no need to suffer more then necessary. It's also a good idea to seek medical consulting.
If it's not over 102 F and it's not interfering with sleep, you can bring a fever down some with plenty of fluids and/or a tepid bath.
My sons hated taking medication. I gave them non drug options on a routine basis for minor ailments because they didn't want to take drugs if they didn't have to.