October 23, 2024, 1:55 pm | Read time: 10 minutes
Your head hums and throbs – you need a tablet to relieve the pain. Some people rely on aspirin; others prefer ibuprofen or paracetamol. But what if the headache is particularly persistent or you don’t have another pill left of the first one you took? Is it then a good idea to combine two or even three different painkillers? FITBOOK author Julia Kuntz asked Prof. Dr. Hartmut Göbel this question. He is the head physician at the Kiel Pain Clinic.
The regular use of painkillers (analgesics) is widespread. In Germany, an estimated 1.9 million people take painkillers every day. Between 30 and 40 percent take them even though they are not in physical pain.1 The easy access to over-the-counter medicines such as ibuprofen, aspirin, or paracetamol is one of the reasons why many people take them more frequently and without medical supervision. Find out from an expert what you should bear in mind when – or better still before – taking them.
Overview
- What is pain, and how does it occur?
- Types of pain
- The three most commonly used painkillers
- Why you should not take combining painkillers lightly
- What specifically happens if I combine the three painkillers?
- General Considerations for Taking Painkillers
- What questions should you ask yourself if you take painkillers from time to time?
- Sources
What is pain, and how does it occur?
“Pain is an unpleasant sensation caused by actual or potential tissue damage,” says Prof. Dr. Hartmut Göbel from the Kiel Pain Clinic. “As a biological pain, it can be a natural protective mechanism of the body to draw attention to harmful stimuli and avoid potential damage. Pain is perceived in the brain after pain receptors (nociceptors) in the skin, muscles, joints, or organs have been activated by injury, inflammation, or other factors. Every person feels pain differently, both in terms of intensity and the way it is perceived.” Pathological pain no longer has this warning function, e.g., in the case of tumor pain. The cause is known. The warning function can also be completely absent in chronic pain.
Types of pain
There are different types of pain, each of which requires specific treatment and diagnostics to target the underlying cause.
- Acute pain: This occurs suddenly and is often short-lived, such as toothache, cuts, or similar injuries.
- Chronic pain: If the pain lasts longer than three months, it is referred to as chronic pain. Back pain or migraines, for example, are particularly common.
- Neuropathic pain: This is caused by damage or malfunctions of the nervous system, e.g., due to diabetes or nerve injuries, and often manifests itself as stabbing pain or numbness.
- Nociceptive pain: Pain due to somatic (arising in bones, skin, and joints) or visceral (arising in the organs) tissue damage, inflammation, or infection is referred to as nociceptive pain, e.g., from sore muscles or broken bones.
- Psychogenic pain: This is pain that can be triggered and maintained by psychological factors such as depression, stress, or anxiety.
- Phantom pain: This is special nerve pain that is felt in an amputated part of the body.
- Central pain: This pain is directly caused in the brain, e.g., after a stroke, as so-called thalamic pain.
The three most commonly used painkillers
1. Ibuprofen
Main active ingredient
Ibuprofen
Effect
Analgesic, anti-inflammatory, antipyretic
Area of application
Most suitable for inflammatory pain, such as joint pain, back pain, arthritis and febrile illnesses.
Do not take for stomach or intestinal ulcers, kidney and liver problems, heart disease, and from the 20th week of pregnancy.
How to take
Take after a meal to avoid stomach irritation.
Risks and side effects
Gastrointestinal complaints, high blood pressure, increased risk of heart attacks, strokes, and kidney problems with long-term use.
Do not combine with:
Aspirin, blood thinners
2. Paracetamol
Main active ingredient
Paracetamol (acetaminophen).
Effect
Analgesic and antipyretic, but has no anti-inflammatory effect. The effect on pain is very weak, approx. twelve patients have to be treated before an effect occurs in one.
Field of application
For mild headaches, toothache, and fever. Paracetamol is often the first choice for sensitive stomachs. In the past, it was also recommended for pregnancy, but there is extensive evidence of possible lasting damage to the child.
Do not take if you have liver disease, alcoholism or severe kidney problems.
Dosage
Do not exceed the recommended daily dose (about four grams for adults).
Risks and side effects
Overdosing can lead to severe liver damage and rarely also causes skin rashes and allergic reactions.
Do not combine with:
Alcohol and other medicines containing paracetamol.
3. Aspirin
Main active ingredient
Acetylsalicylic acid (ASS)
Effect
Analgesic, anti-inflammatory, antipyretic, and blood-thinning.
Indication
For mild to moderate pain, e.g., headache, migraine, or toothache.
Do not take in the case of stomach or intestinal ulcers, blood clotting disorders, or asthma.
How to take
Always take with a glass of water and after a meal to avoid stomach irritation.
Risks and side effects
Stomach discomfort, heartburn, risk of bleeding, allergic reactions and kidney problems.
Do not combine with:
Blood thinners, corticosteroids, ibuprofen
Why you should not take combining painkillers lightly
“Combining painkillers poses health risks, as different medications have different effects on the body and interactions can occur,” explains Prof. Dr. Hartmut Göbel. “They can influence each other and strengthen or weaken the effect of the other. For example, taking two painkillers at the same time, both of which affect the central nervous system, can significantly increase the risk of side effects such as drowsiness.”
There is also an increased risk of overdose, especially with opioids and over-the-counter medications that are considered harmless. As many painkillers are metabolized (broken down) in the liver, taking several painkillers at the same time can place a heavy burden on the liver and increase the risk of liver and kidney damage.
Certain painkillers, especially non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin, can cause gastrointestinal problems such as gastrointestinal complaints. Taking them at the same time can significantly increase the risk of stomach ulcers or bleeding.
It is strongly advisable to follow the doctor’s or pharmacist’s instructions and to be careful when combining painkillers.
What specifically happens if I combine the three painkillers?
Ibuprofen in combination with paracetamol
The combination of ibuprofen and paracetamol can be an effective method of treating pain, as they have different mechanisms of action. Ibuprofen has an anti-inflammatory and pain-relieving effect, while paracetamol mainly has an analgesic and antipyretic effect. The combination can relieve pain to a greater extent, as the effects complement each other. This, in turn, can help to reduce the dosage of the individual medications and thus minimize the general side effects. However, the recommended dosage should always be observed in order to avoid kidney and liver damage as well as stomach problems. On the other hand, the side effects of the medication can also add up and even potentiate each other. For this reason, you should take a painkiller at the recommended dose and not combine different substances.
Paracetamol in combination with aspirin
The combination of paracetamol and aspirin can also lead to greater pain relief and fever reduction, as the two have different mechanisms of action. Paracetamol has an analgesic and antipyretic effect, while aspirin also has an anti-inflammatory and blood-thinning effect. Aspirin increases the risk of gastrointestinal complaints such as irritation or bleeding, although this is not increased by the combination with paracetamol. Nevertheless, these medications should only be taken at the same time after consulting a doctor in order to minimize side effects.
Hands off: Ibuprofen in combination with aspirin
A combination of ibuprofen and aspirin is strongly discouraged, as both drugs have similar effects. Taking them at the same time can significantly increase the risk of side effects such as gastrointestinal bleeding, ulcers, and kidney damage. In addition, ibuprofen can reduce the blood-thinning effect of low-dose aspirin, which is taken to prevent heart attacks. The two medications should, therefore, only be used together after consulting a doctor.
Combining ibuprofen, aspirin, and paracetamol is not a good idea
“Taking paracetamol, ibuprofen, and aspirin at the same time is risky, as they have different mechanisms of action but can cause significant side effects when taken together. Ibuprofen and aspirin can greatly increase the risk of gastrointestinal bleeding, ulcers, and kidney damage, while paracetamol mainly affects the liver. Even changing these drugs daily does not significantly reduce the risk, as the cumulative burden on the stomach, kidneys, and liver remains. Such a combination is pointless and should not be used,” says Prof. Dr. Hartmut Göbel.
General Considerations for Taking Painkillers
- Dosage: Never take painkillers in higher doses or more frequently than recommended. An overdose can cause serious health risks such as liver damage (with paracetamol) or stomach problems (with ibuprofen or aspirin).
- Duration of use: Only use painkillers for the prescribed duration and consult a doctor if the pain persists.
- Interactions: Painkillers can interact with other medications, so taking different medications at the same time should only be done on medical advice.
- Not on an empty stomach: Many painkillers can irritate the stomach, and they should not be taken on an empty stomach; they should be taken with sufficient water.
- Individual intolerances: Some people are sensitive to certain active ingredients, which is why the package leaflet should always be read carefully.
- Alcohol consumption: Painkillers should not be taken with alcohol, as this increases the risk of side effects, particularly liver and stomach problems.
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What questions should you ask yourself if you take painkillers from time to time?
- Why am I taking painkillers?
What is the cause of my pain? Am I only treating the symptoms or also the underlying cause? Do I have acute or chronic complaints? When and how often do they occur? A pain diary with details of the periods and intensity of pain can help you get to the bottom of the causes and provide important information for your next visit to the doctor. - How often do I take painkillers?
Is my use regular or only in exceptional cases? Is there a risk that I will become dependent? - Do I follow the recommended dosage?
Do I know the recommended dosage and do I follow it, or do I take more than prescribed? - What side effects could occur?
Am I aware of the possible short-term and long-term side effects? Have I possibly already experienced any? Am I a high-risk patient for certain side effects? - Will the painkiller affect any other medication I am taking?
What other medications am I taking? Are there any interactions with other preparations? - Are there alternative treatment methods?
Could I manage without painkillers? Have I sought advice on whether my pain can be alleviated by physiotherapy, relaxation techniques, or other non-drug approaches, for example? - How does the painkiller affect my everyday life?
Does it cause fatigue, dizziness, or other impairments? - Have I consulted a doctor or pharmacist about my painkiller use?
Is my intake medically prescribed and safe? Am I being honest with my doctor about my consumption? Do I have the right doctor at my side to get to the bottom of the causes of my pain in the long term?
With expert advice from Prof. Dr. Hartmut Göbel, Chief Physician at the Kiel Pain Clinic