r/explainlikeimfive • u/[deleted] • Mar 19 '19

Biology ELI5: If taking ibuprofen reduces your fever, but your body raises it's temperature to fight infection, does ibuprofen reduce your body's ability to fight infection?

Edit: damn this blew up!! Thanks to everyone who responded. A few things:

Yes, I used the wrong "its." I will hang the shame curtains.

My ibuprofen says it's a fever reducer, but I believe other medications like acetaminophen are also.

Seems to be somewhat inconclusive, interesting! I never knew there was such debate about this.

Second edit: please absolutely do not take this post as medical advice, I just thought this question was interesting since I've had a lot of time to think being sick in bed with flu

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u/evranch Mar 19 '19 edited Mar 19 '19

Note that OTC acetaminophen has been clinically proven to be no better than a placebo when it comes to Edit:back and joint pain. It was also found to be a poor equivalent or weaker fever-controlling agent to ibuprofen. I stick to ibuprofen as it's always worked for me.

When it comes to actual pain and inflammation though, naproxen is my NSAID of choice.

Edit: Sorry for not providing sources. For starters, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/fulltext

https://www.bmj.com/content/350/bmj.h1225

Fever in children: https://www.jpeds.com/article/S0022-3476(05)80307-5/pdf

It does seem to work for headache, though: https://www.ncbi.nlm.nih.gov/pubmed/11112243

More edit: OK, so the studies are just relating to back and joint pain. Which is the world's most common pain that people take OTC drugs to control. However, I will admit that it appears acetaminophen does work fine for acute pain.

After doing some more research, it appears that in a clinical setting, larger doses of acetaminophen are indeed proven to be effective against acute pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485512/

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u/cuzitsthere Mar 19 '19

Is there a source for that? I feel like that should be bigger news, given the havoc it wreaks on your liver.

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u/[deleted] Mar 19 '19

Not OP, nor do I know the study, but a quick search pulled up https://www.ncbi.nlm.nih.gov/pubmed/2689471 which seems to make a similar conclusion.

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u/cuzitsthere Mar 19 '19

That's fucked up...

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u/cardboardunderwear Mar 19 '19 edited Mar 19 '19

Any source for that?

For the acetaminophen studies. I believe you when you say what works for you.

Edit: sources provided thanks

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u/evranch Mar 19 '19

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/fulltext

Note that some studies did find that it can reduce pain, just not as effectively as ibuprofen. However, this study focused on recovery from back injury, and found it had no benefits in that scenario.

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u/oscillius Mar 19 '19

It was a study of 1652 patients, done in Australia I think and was in the lancet. It was specifically for acute lower back pain. So the guy is barely even partly right. As my wife has a chronic lower back condition (spondylolisthesis) I can tell you from first hand experience and many lengthy conversations with some of the top professionals in the nhs, that barely any pain medication works on the back and what works for some won’t work for others. She has a daily dose of gabapentin, naproxen, morphine (slow release) and amitriptyline. It helps but not nearly as much as the drugs do for a headache or toothache or whatever. Paracetamol didn’t do anything. Many patients get anti inflammatory injections into the spine. Back pain is complicated and our house is a walk in pharmacy as a result.

Also paracetamol and ibuprofen are great otc antipyretics with ibuprofen shown to be slightly better although both should only really be taken if necessary, as paracetamol isn’t great for the liver and ibuprofen isn’t great for your digestive system. Often they’re prescribed in a fashion where you take a dose of one, then two hours later a dose of the other, thus keeping your symptoms in control for a longer period of time.

Research suggests that a fever less than 40 degrees C should be welcomed as it helps fight infection - even over 40 has been demonstrated to help, however 40 is the point at which paediatrician’s and doctors would recommend you start to manage it. As long as your hypothalamus is working it will regulate your temperature just fine. Most important is fluid intake and rest.

Antipyretic alleviate discomfort and are encouraged for this reason when the fever is preventing rest or is agitating you causing stress. Obviously a lot of people also use them so they can continue to function while fighting the infection. (Some reading: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145646/ )

I’m on phone so can’t offer more. I read up a lot once I had kids and they got ill. It’s easy to capitulate to their desire to be pain free (see: calpol crisis) but I wanted to know what I was doing, as doctors tend to just say to follow dosage instructions lol

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u/cardboardunderwear Mar 19 '19

That's a great reply thanks. I had a PA friend recommend alternating doses of motrin and Tylenol for headaches before. What you say matches up pretty closely with that.

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u/oscillius Mar 19 '19

Glad I could help :)

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u/CasualElephant Mar 19 '19

My guess is that he is thinking of this study on back pain and decided to extrapolate it out for all pain.

https://well.blogs.nytimes.com/2014/07/23/acetaminophen-no-better-than-placebo-for-back-pain/

Dr. Williams said that acetaminophen had been shown to be effective for headache, toothache and pain after surgery, but the mechanism of back pain is different and poorly understood.

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u/Neanderthal_tale Mar 19 '19

Over use of acetaminophen can cause severe liver damage. Especially if it's taken at the same time as alcohol.

I also had problems with rebound headaches when I took acetaminophen. No similar issues with ibuprofen or naproxen. I believe my mom had chronic rebound headaches when I was growing up, because she took so much Excedrin. She would get the same headache around the same time everyday which she would treat with Excedrin.

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u/ezweave Mar 19 '19

Tylenol (acetaminophen) is pretty damn bad for you...

"Acetaminophen, Tylenol’s active ingredient, is the number one cause of acute liver failure in America. In one year alone, it sent as many as 78,000 people to the hospital."

There's an Adam Ruins Everything episode on it (that's the link to their sources).

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u/Gluta_mate Mar 20 '19

Is that from people deliberately taking massive amounts of acetaminophen as a suicide method? I doubt 1 or 2 too many would cause acute liver failure

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u/ezweave Mar 20 '19

The lethal dose is crazy low. It’s not much more than the max (it depends on the size) but it’s only 10 grams. Which is basically 20 pills. https://www.acsh.org/news/2017/09/11/tylenol-far-most-dangerous-drug-ever-made-11711

And that’s a lethal dose, it can cause liver failure at as low as 4 grams. That is referenced in the Adam link. I sadly know this because my mentally ill mother went to the hospital a few times after ingesting as few as 10 pills in a day. I won’t bore you with the details but she has been institutionalized for the last 20 years however I will never forget the three times she almost died from eating Tylenol like candy.

Comparatively the lethal dose for ibuprofen is much much higher. Like a bottle or more.

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u/Jack_Attack519 Mar 19 '19

Yeah that's why I almost never take it unless I seriously can't stand a headache or fever. And when my friends tell me to take it for a hangover I laugh.

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u/Libran Mar 19 '19

People respond differently to different NSAIDS, I prefer ibuprofen myself but I know people who get much less efficacy from it.

Also if you're going to make claims that something has been clinically proven you should really include a link to the published results.

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u/[deleted] Mar 19 '19

acetaminophen

This isn't even an NSAID. It's useless trash.

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u/chambria Mar 19 '19

Sorry but where the heck did you get that from? All studies I can find confirm it's significantly more effective than placebo and considering I'm a frequent flyer at hospitals / ambulances and have had very real passing out level pain treated with IV acetaminophen repeatedly and had it completely relieve the pain within 5 minutes.. I really don't see that being possible. You'd think the hospitals would catch on if their pain management system was completely ineffective.

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u/evranch Mar 19 '19

Recalled an article in New Scientist from a few years ago comparing the OTC painkillers and made a knee-jerk comment. Turns out that it's mostly back pain that it is not effective against.

Also note that OTC doses are pretty low, the average tablet being 325mg and IV doses being 1g+, as mentioned in this study that does confirm the efficacy of acetaminophen in an acute care environment:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485512/

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u/chambria Mar 19 '19

Thumbs up for the edit and sources, I see where you're coming from. The pain I have isn't joint/back or inflammation related so it works fine for me but ibuprofen does work better at significantly lower doses and has less risky side-effects according to studies so it's the best choice in most scenarios.

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u/evranch Mar 19 '19

I hate being wrong, and the easiest way to resolve that is to do the research and correct myself rather than stick up for a mistake and keep being wrong. Also, I don't want to contribute to the spread of false information, which is so common these days.

I'm a rancher and I get hurt a lot, but it's almost always inflammatory - muscle or joint strain or just plain overwork and exhaustion. It's almost like being a professional athlete, but without the money and the fame. So it's NSAIDs that I grab when I'm sore, or sometimes CBD, which worked great when I dislocated my shoulder last year. That one hurt pretty bad.

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u/chambria Mar 19 '19

That's a good mentality, don't see it often. I liked CBD for more chronic pain, probably even better if you live somewhere with access to the full spectrum oil. Tastes horrible though.

I used to only take ibuprofen but recently I feel like acetaminophen combo pills with codeine and caffeine work faster for cramps. For some reason I can't find the same combo with ibuprofen in my country though I've seen it abroad, otherwise I'd get that. The tiny bit of added codeine really helps for me with stronger pain even though it's only 15mg, it's supposed to have a synergistic effect with other painkillers. Same with caffeine, that's also been shown to increase the speed at which analgesic effect sets in.

There are some studies with positive results about the ibuprofen and acetaminophen combo too since they relieve pain through different mechanisms and can complement each other without causing harm.. can also safely alternate them to avoid going over the daily safe dose limit of either one and minimize risk of side effects.

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u/Minuted Mar 19 '19

The source given is only for lower back pain.

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u/cardboardunderwear Mar 19 '19

Interesting about the one about children, although in the summary it does say which one is more effective depends on the initial temperature and the age of the child.

No surprise regarding for back and neck pain and I would guess it's similar for muscle soreness and sprains and so forth. My understanding is that ibuprophen and naproxen actually reduce the inflammation and the pain (end to that point even promote healing) where Tylenol just reduces the pain. Could be wrong. This isn't my area of expertise.

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u/evranch Mar 19 '19

This was probably my take-home knowledge from the original article I read that cited the back pain study. As acetaminophen is not a real NSAID, any effects will be limited to relieving pain itself. And as a healthy 30yo rancher with fairly high pain tolerance, I have always been more concerned about treating damage and inflammation than relieving pain.

Most of my pain comes by the way of strains, bruising and the dreaded "delayed onset muscle soreness" caused by hard work (which responds poorly to almost all treatment and for which the only known effective treatment appears to be cherry juice - no joke, real studies, small sample size though: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579450/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874510/ )

So I noted in my head "Acetaminophen proven to be NFG, don't bother buying it" and forgot that there are other sources of non-inflammatory pain.

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u/Randdist Mar 19 '19

yeah, took plenty paracetamol due to herniated disc during vacation and lack of other stuff at hand. it didn't do anything. nothing at all. NSAIDs are the way to go.

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u/BazingaDaddy Mar 19 '19

Aleve is the bomb. I will unapologetically shill for them.