How does paracetamol work and should you be using it?

Paracetamol has been commonly used and readily available since the 1950s as an over-the-counter pain relief option. Despite being so widely used, there is still limited understanding of how paracetamol actually works.

How does paracetamol work?

The mechanisms of how paracetamol works are complex and multifaceted, and current research continues to explore these intricacies. Some explanations of how paracetamol works involve chemical messengers of inflammation and pain. Others involve aspects of neurotransmission in the brain and spinal cord. 

None of the proposals have accumulated enough supporting evidence to satisfy everyone. One mechanism researchers have looked into is that paracetamol blocks cyclooxygenase (COX) enzymes. These help to form prostaglandins, which are pain and inflammation-mediating signalling molecules. This would make paracetamol similar to aspirin, or ibuprofen. But in fact, paracetamol is still poorly understood and remains in a class of its own.

Why might you use paracetamol?

People generally take paracetamol because they're in pain. Paracetamol may be used for pain such as headaches, backache, period pain, toothache or aches and pains as a symptom of cold and flu. Although two people may have the same pain condition, their experience of living with pain, treatment options, and treatment effectiveness can be vastly different.

Paracetamol remains popular due to tolerability and safety when taken at recommended doses. You might take paracetamol for; mild to moderate pain, fever, osteoarthritis and other painful non-inflammatory conditions. 

Paracetamol dosage for adults per day

The dose of paracetamol for adults is; one or two 500mg tablets every four to six hours, up to a maximum of eight tablets in 24 hours. Paracetamol may be given to children from one month of age for pain and fever and given at a dose based on their weight and age.  

Speak to your healthcare professional if you are not sure or have any questions. Always read the label and follow the directions for use. Incorrect use could be harmful.

Potential risks to be aware of

There are many alternative therapies that may be used to manage pain instead of paracetamol. Alternative therapies include acupuncture, yoga, aromatherapy, massage, herbal and nutritional remedies as well as many others.

Acupuncture.  This ancient medical practice originated in China over 2,000 years ago and is considered a form of complementary or alternative medicine. It is based on the principles of traditional Chinese medicine, which posits that the technique helps clear energy blocks and promotes the normal flow of energy, or "Qi," in the body. The exact mechanisms of how acupuncture provides pain relief are not completely understood in the context of modern medical science but it may be helpful for pain relief as well as other health conditions.

Massage is being increasingly used by people suffering from pain, mostly to manage chronic back and neck problems. Massage reduces stress and relieves tension by improving blood flow. This treatment also may reduce the presence of substances that may generate and sustain pain. Current studies show that massage therapy, like chiropractic manipulations, holds considerable promise for managing acute and chronic pain.

Herbal alternatives to paracetamol

Some herbs are often explored for their potential analgesic properties and may be considered as alternatives to traditional pain medications like paracetamol. However, it’s important to note that the effectiveness and safety of these herbs may vary, and they may not work for everyone. 

Consulting with a healthcare professional before using herbal remedies for pain management is advisable. 

• Ginger (Zingiber officinalis) is known to have a number of potential health benefits in the body including relief from muscle pain, headaches and arthritis.  
• Devils Claw (Harpagophytum procumbens) This South African herb is traditionally used to treat rheumatoid and osteoarthritis. 
• White Willow Bark (Salix alba) This herb contains salicin, an aspirin-like compound, and white willow bark has long been used as a natural remedy for inflammation and pain. One study in particular found this herb to be beneficial for pain reduction in patients with arthritis. 
• Indian Frankincense (Boswellia serrata). Commonly used in Ayurvedic medicine, this resinous gum is rich in boswellic acid and may have anti-inflammatory effects on the body. One study found it may be an effective treatment for patients with osteoarthritis.
• Turmeric (Curcuma longa)This herb is from India and Indonesia. It has traditionally been used for its antiseptic qualities, as an agent to reduce inflammation in wound care, and also valued for its antioxidant properties and pain-relieving effects.

Consider your diet 

There is extensive research that suggests there's a strong link between diet and inflammation. Inflammation is your body's response to injury or infection. Inflammation causes heat, redness, swelling and pain. While this normal immune system response is important for healing, sometimes inflammation may become chronic. Long-term inflammation is linked to several diseases and conditions, such as rheumatoid arthritis and heart disease.

Instead of going down the pharmaceutical road and taking paracetamol, the inflammation may be able to be managed with diet. It is believed though that certain foods offer protection against inflammation, while other foods might actually encourage inflammation.

Anti-inflammatory foods

The nutrients in some foods have anti-inflammatory or analgesic properties that may help relieve pain. Anti-inflammatory foods include omega 3’s found in fish.

Omega-3 fats play a role in altering the inflammatory process and regulation of pain. Salmon, tuna, trout, mackerel and herring are high in these fats. 

Soy-based foods, walnuts, pecans and ground flaxseed are also good sources of omega-3 fats.

Pro-inflammatory foods

Pro-inflammatory foods are foods that may contribute to inflammation. Most processed foods are pro-inflammatory, they tend to be high in unhealthy fats, added sugars, preservatives and refined carbohydrates. Deep-fried foods, pastries, processed cereals, white rice, white potatoes, sugar, breads and red meat are all pro-inflammatory foods.

Antioxidant-rich foods

Antioxidant-rich foods, such as colourful fruits and vegetables, leafy greens, avocados, beets and berries, are all rich in antioxidants. Antioxidants may help to repair some types of cell and tissue damage. Antioxidants include certain vitamins, minerals and plant chemicals, such as vitamin C, vitamin E, carotene, lycopene and flavonoids.

Related Reads:

• When to use ice or heat for lower back pain
• Menstruation: What it is, what’s normal and how to help to manage any pain
• Why dehydration can cause headaches and what to do about it

References:

1. Ayoub, S. S. (2021). Paracetamol (acetaminophen): A familiar drug with an unexplained mechanism of action. Temperature, 8(4), 351–371. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8654482/ 
2. https://www.healthdirect.gov.au/paracetamol#how 
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pain-and-pain-management-adults#pain-management-strategies 
4. https://www.healthdirect.gov.au/acupuncture  
5. https://www.healthdirect.gov.au/remedial-massage 
6. Jahromi, B., Pirvulescu, I., Candido, K. D., & Knezevic, N. N. (2021). Herbal Medicine for Pain Management: Efficacy and Drug Interactions. Pharmaceutics, 13(2), 251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918078/
7. Yu, G., Xiang, W., Zhang, T., Zeng, L., Yang, K., & Li, J. (2020). Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complementary Medicine and Therapies, 20(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368679/ 
8. Lin, C.-R., Huang, S., Che, W., Lee, C., Hung, S.-W., Ting, Y. M., & Hung, Y. (2023). Willow Bark (Salix spp.) Used for Pain Relief in Arthritis: A Meta-Analysis of Randomized Controlled Trials. Life, 13(10), 2058–2058. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607963/
9. https://www.niehs.nih.gov/health/topics/conditions/inflammation/index.cfm 
10. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-021-00674-9 
11. https://www.betterhealth.vic.gov.au/health/healthyliving/antioxidants