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Painkillers: which helps when? Paracetamol, acetylsalicylic acid, ibuprofen,

diclofenac: many consider pain relievers to be almost the same. But there are

differences in effectiveness and side effects

BY ULRICH KRAFT, UPDATED ON MAY 17TH, 2019 Medication tablets Painkillers:

Common and sometimes taken carelessly

© dpa picture alliance / Franziska not connected to Facebook Facebook "share"

dummy not connected to Twitter "Tweet this" dummy Fever and aching limbs

because of this persistent cold? It gets better with acetaminophen. Sprained

your sports? With ibuprofen or diclofenac it doesn't hurt anymore.

That annoying headache again ? As if blown away, thanks to acetylsalicylic

. Paracetamol, acetylsalicylic acid, ibuprofen and diclofenac are among the

best-selling active ingredients among the over-the-counter pain relievers

At least one of these drugs is in almost every household in the

medicine cabinet. Every day they are bought anew umpteen times. It is difficult

to say exactly which quantities of individual agents go over the counter in

pharmacies, because all four pain relieving active ingredients are available

without a prescription - at least up to a certain dosage.

Deciding based on personal preference is tricky Perhaps it is due to the

commonality of the freedom from prescription that the preparations are viewed

by many consumers as more or less similar. Personal experiences and preferences

often determine whether someone swallows ibuprofen in pain or prefers to use

acetaminophen. The substances are by no means identical, as Professor Hans-

Raimund Casser emphasizes. "Each of the drugs has a different chemical

structure," says the medical director of the DRK Pain Center Mainz. "That is

why there are differences in the mode of action, the possible side effects and

the areas of application."

Mode of action of ibuprofen, diclofenac and acetylsalicylic acid Ibuprofen,

diclofenac and acetylsalicylic acid (ASA) are non-steroidal anti-inflammatory

drugs, NSAIDs for short. The name has historical reasons, since the substances

were originally used to treat patients with rheumatoid arthritis. Although

acetylsalicylic acid was the first NSAID to appear on the market at the end of

the 19th century, its mechanism of action was only deciphered by John Robert

Vane in the early 1970s. The British biochemist and pharmacologist, who

received the Nobel Prize in Medicine in 1982, demonstrated that the NSAIDs

inhibit cyclooxygenase (COX). This enzyme is indispensable in the human

organism for the production of prostaglandins - a group of tissue hormones that

have a variety of functions and effects.

There are two sub-forms of cyclooxygenase called isoenzymes. The non-steroidal

anti-inflammatory drugs develop their desired effects primarily by blocking

cyclooxygenase-2 (COX-2). This is always particularly active when tissue in our

body is damaged, for example by injuries or inflammation. The prostaglandins

that are then produced increase the sensitivity of the pain receptors and thus

fuel the sensation of pain. In addition, they increase the setpoint of body

temperature in the brain center for heat regulation - with fever as a result -

and promote inflammatory processes.

How do painkillers work? This also explains our video:

© W & B / Edeos "In addition to their analgesic, i.e. pain-relieving, effects,

NSAIDs also have antipyretic and anti-inflammatory effects," explains pain

therapist Casser. "Therefore, they are particularly suitable for inflammatory

." In addition, ASS, Ibuprofen and Diclofenac accumulate

in inflamed tissue due to their chemical structure. This makes them even more

effective for inflammatory pain.

Paracetamol is less anti-inflammatory This property lacks paracetamol. In

general, the anti-inflammatory effect of this over-the-counter pain reliever is

That is why paracetamol is not one of the "non steroidal anti-

inflammatory drugs" (NSAIDs) in the English-speaking world.

Exactly how the substance works is still incomplete. It is known that

paracetamol has its analgesic and antipyretic effects mainly in the central

nervous system, i.e. in the spinal cord and in the brain . There it inhibits

COX-2 and probably also interferes with other messenger systems involved in

pain sensation, such as that of the so-called endocannabinoids.

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