Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions
Version of Record online: 22 DEC 2014
© 2014 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFICC®.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
European Journal of Pain
Volume 19, Issue 9, pages 1213–1223, October 2015
How to Cite
Moore, R.A., Derry, S., Wiffen, P.J., Straube, S. and Aldington, D.J. (2015), Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. European Journal of Pain, 19: 1213–1223. doi: 10.1002/ejp.649
The Oxford Pain Relief Trust provided institutional support, and Reckitt Benckiser provided an unrestricted educational grant.
Conflicts of interest
The authors have no known conflicts of interest. RAM is the owner of Oxford Medical Knowledge (OMK), which received an unrestricted educational grant from Reckitt Benckiser. PW acted as a paid consultant to OMK for this project. SS has previously participated in a grant from Reckitt Benckiser.
- Issue online: 24 SEP 2015
- Version of Record online: 22 DEC 2014
- Manuscript Accepted: 20 NOV 2014
- Oxford Pain Relief Trust
- Reckitt Benckiser
Ibuprofen and paracetamol have long been used as analgesics in a range of acute, intermittent and chronic pain conditions. Paracetamol is often the first line analgesic recommended, without consensus about which is the better analgesic.
An overview review of systematic reviews and meta-analyses directly compares ibuprofen and paracetamol at standard doses in particular painful conditions, or uses indirect comparisons against placebo. Electronic searches for systematic reviews were sought published since 1995 using outcomes approximating to ≥50% pain intensity reduction. Painful conditions were acute post-operative pain, dysmenorrhoea, tension-type headache (TTH), migraine, osteoarthritis and rheumatoid arthritis, back pain, cancer and paediatric pain. There was no systematic assessment of harm.
Sixteen systematic reviews and four individual patient data meta-analyses were included. Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions. Two direct comparisons favoured ibuprofen (acute pain, osteoarthritis). Three of four indirect comparisons favoured ibuprofen (acute pain, migraine, osteoarthritis); one showed no difference (TTH), although there were methodological problems. In five pain conditions (dysmenorrhoea, paediatric pain, cancer pain, back pain and rheumatoid arthritis), there were limited data on paracetamol and ibuprofen.
At standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions.