Which painkiller do you reach for when you’ve got a throbbing headache or a stiff, achy knee? Chances are it’s paracetamol, if you live in Britain. We buy 6,300 tonnes of this cheap, easy-to-find medication every year, according to an estimate from the University of Oxford, and most of us have a packet in the bottom of our bags, or the back of our cupboards.

Pharmacists often recommend paracetamol to treat minor ailments, yet some clinical trials indicate that it’s no better than a placebo when it comes to treating back pain or arthritis. Step forward ibuprofen, the other cheap, white painkilling pill on our shelves that we’re less likely to pick up: this less-loved treatment does in fact take the edge off in a real way, evidence suggests, at least when it comes to pain in your lower back – and it could even lower your risk of dementia and Parkinson’s.

The truth is, “both paracetamol and ibuprofen are good for treating different things,” says Aldrin Gomes, a professor at the medical school at the University of California, Davis. Ibuprofen is “an anti-inflammatory drug”, and therefore works on issues to do with inflammation, such as joint pain and toothaches. Paracetamol has its place too: it is a more effective weapon against sore heads and throats, as well as fevers.

Prof Gomes recently published a book about all of the unexpected effects of ibuprofen, called The Comprehensive Guide to Ibuprofen: The Good, The Bad and The Unexpected. There is so much more to both of these drugs than meets the eye, he says. Here is how they differ, which is best for what, and why they should only be taken when you absolutely need them.

The surprising benefits of ibuprofen
One recent study from the University of Cambridge has found that taking ibuprofen could lower the risk that someone develops dementia by at least 14 per cent, while it has been shown in multiple studies that it can also lower your risk of Alzheimer’s, a form of dementia.

“One piece of research, with participants who were all veterans, found that those who used ibuprofen rather than paracetamol for more than five years, were 40 per cent less likely to develop Alzheimer’s,” says Prof Gomes. Those in the study were engaging in occasional use rather than habitual use, but were taking it at least once a month. “It’s not a smoking gun, but it’s a pretty strong correlation,” Prof Gomes adds.

Recent findings also indicate that people who take ibuprofen have a significantly lower risk of developing Parkinson’s disease. Both Alzheimer’s and Parkinson’s diseases are linked to inflammation in the body, and it’s by working on this same mechanism that ibuprofen is a much more effective treatment for joint pains and strains than paracetamol is.

The risks

It’s not that there are no downsides to ibuprofen, however. Taking it, and taking it regularly in particular, can reduce the diversity of your gut microbiome, and a vibrant gut is important to preventing Alzheimer’s in itself (as well as bowel cancer, cardiovascular disease and mood disorders). More information is needed to fully understand the costs and benefits that come with painkillers.

There are also other side effects – and you may find them surprising. “Of a 100 people who take ibuprofen, three will get diarrhoea,” says Prof Gomes. For paracetamol, “the figure is somewhere between one and ten,” he says, but with either drug, “you’d be much more likely to blame a symptom like that on what you’ve eaten, even though they’re both known to commonly cause diarrhoea,” he adds.

Long-term paracetamol use, meanwhile, has been linked to an increased risk of heart attacks. One 2015 study found that people who take at least 15 paracetamol pills a week were at a 68 per cent higher risk of a cardiovascular event – in other words, a heart attack. Ibuprofen is not in the clear either. Taking it regularly can also lead to an increased risk of heart attacks “by a small amount”, according to a University of Oxford study.

Both pills are considered safe to take in their recommended doses for up to a fortnight at a time, Prof Gomes says. “But once you start taking ibuprofen every day for three weeks or a month, the evidence suggests that you’re increasing your risk of a stroke by at least 30 per cent.” Of those who take it consistently for months on end, “25 per cent will get chronic high blood pressure,” Prof Gomes adds.

Regularly taking paracetamol, meanwhile, “can lead to major liver damage”, and this is “especially bad when someone is also drinking alcohol”, says Prof Gomes. It can also cause anaemia, “as it interferes with the body’s production of red blood cells”.

There is increasing evidence that paracetamol used in pregnancy “can cause neurodevelopmental disorders including ADHD in children,” Prof Gomes says. Paracetamol’s effects last for a shorter period of time, he adds, making it less suitable for children (who may be more prone to waking up in the night with coughs and colds), and more likely to be taken more frequently than is considered safe.

How do ibuprofen and paracetamol work?

Both paracetamol and ibuprofen work to kill pain by blocking the signals from your body that tell your brain that you’re in pain. “Ibuprofen blocks two very important enzymes, called COX-1 and COX-2. These break down lipids [fats in your body] into prostaglandins, which are chemicals that are involved in pain,” Prof Gomes explains. If you block these enzymes then you block pain, “as well as inflammation,” he says.

Paracetamol doesn’t block prostaglandins in the same way, which means that the drug isn’t anti-inflammatory. It does interfere with the chemical signals involved in feeling pain, however, as well as with the part of your brain that handles temperature regulation, which is why it can also be helpful for fevers. “Another difference is that paracetamol is processed by the liver, while ibuprofen is processed by the kidneys,” Prof Gomes adds.

Given its anti-inflammatory properties, ibuprofen works best on pain that involves inflammation, such as back pain, period pain, arthritis and toothaches. Paracetamol works best for “simple pain without inflammation,” says Dr Gomes: cuts, scrapes, headaches and stomach aches, as well as high temperatures. Both can be used in combination – for example, you might want to take paracetamol and ibuprofen at the same time to handle the aches and pains as well as the fevers that can come with a bad cold. It’s important not to take both unnecessarily, however.

So which is best – ibuprofen or paracetamol?
On the whole, “I would generally recommend that people take ibuprofen rather than paracetamol,” says Prof Gomes. However, even though its use has been associated with a reduced risk of diseases like Alzheimer’s, “you should only take either paracetamol or ibuprofen if you absolutely need it,” he says. “Research shows that over time, taking painkillers can actually cause your body to produce more pain in the long term, even if it’s eased for a while.”

For that reason, as well as all the other side effects that can come with these drugs, Prof Gomes and experts like him now recommend that people take the smallest dose possible that works for them, rather than the dose stated on the packet. “People who weigh 120lb [between 8 and 9st] or less might find that a dose of 100mg, or around half a standard ibuprofen pill or a fifth of a paracetamol tablet, might be enough to ease their symptoms.”

Prof Gomes himself weighs around 160lb, or just over 11st, and “I also take 100mg, because I find that it works for me too,” he says. “It’s worth experimenting and seeing how little you actually need.” Despite the protection against Alzheimer’s that taking ibuprofen regularly might offer, “I also wouldn’t recommend that you take it unnecessarily for this reason either,” he adds. “The benefits need more exploration, but we do know that taking painkillers regularly can worsen your health in the long run.”

If possible, it’s best to rely on alternatives to pain relief medications, such as hot water bottles, massages and deep breathing, Prof Gomes says. “It’s like going to the gym. If you can withstand the pain without taking painkillers, then you will become better at managing it in the long-term.”

FAQs

Can you take ibuprofen and paracetamol together?

“Yes,” says Prof Gomes. He recommends that people take the smallest possible dose of both. “It can be better to have smaller amounts of both than a larger amount of one, as they are processed in different parts of your body,” he says.

Which one is better for back pain, ibuprofen or paracetamol?

“Ibuprofen will generally be better for back pain, due to its anti-inflammatory properties,” Prof Gomes says.

Which painkiller is best if you have a cold or flu?

Paracetamol is best for easing the high temperature or fever that comes with a cold, as well as for relieving any pain such as a headache or sore throat. You can also small amounts of both paracetamol and ibuprofen if you’re suffering from sinus pressure or a sinus headache since ibuprofen specifically targets inflammation. However, don’t take both unnecessarily.

Is ibuprofen bad for your gut?

Yes, taking ibuprofen regularly can reduce the diversity of your gut microbiome so it’s important not to take ibuprofen unless you really need it.

Which painkiller is best for period pain?

Ibuprofen is best for period pain as period pain is usually a result of inflammation.

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