Aspirin, ibuprofen, paracetamol: What to look for in painkillers

Whether it's a headache, regular symptoms or a tormenting pull in the tooth: in order to be prepared for pain attacks, many prescription drugs are available at home. What should be taken into account when suffering from pain? The most important questions and answers.

How do painkillers work?

The mechanisms of action depend on the type of analgesic:

Over-the-counter analgesics such as ibuprofen, aspirin and diclofenac are among the so-called non-opioid analgesics . They inhibit the production of certain messengers involved in the transmission and perception of pain in the brain. Since these also play a role in inflammation, the funds also act partly fever-reducing and anti-inflammatory.

In addition, there are opioid painkillers , which, however, usually have to be prescribed and used for severe acute or chronic pain. Opioids, which include endorphins, among others, belong to the body's own substances with analgesic effects. Among other things, they help people with a shock often feel no pain.

Painkillers with artificial opioids dock at the same places in the body as the natural opioids, but can also be mood-enhancing or calming. As a result, they harbor an enormous potential for dependence. In the US, this was underestimated for a long time, the drugs were prescribed by doctors too lightly. The result is an opioid epidemic.

Is there a habituation effect?

"Yes, and that is really a problem," says Thomas Isenberg, Managing Director of the German Pain Society in Berlin. According to his information almost every second adult attacks at least once over four weeks without prescription painkillers. The intake often takes too long.

"Up to one-third of analgesic users do not know their recommendations for use," says Isenberg. The prolonged use of analgesics without medical advice can lead to a habituation effect - and involves many health risks.

How long should one take painkillers in one go?

"That depends," explains Ulrich R. Fölsch, a specialist in internal medicine and gastroenterology in Kiel. It makes a difference whether you know where the pain is coming from - such as a headache after a night of drinking - or if the causes of the pain are unclear.

"It is wrong, for example, to have abdominal pain without knowing the cause and then to take more than one painkiller without medical advice," says Fölsch, who also works as secretary general of the German Society of Internal Medicine. Because behind the abdominal pain may conceal an appendicitis, which must be treated urgently.

For pain, the cause of which is clear - for example, regular symptoms -, the rule of thumb applies: At most three days in a row and ten days a month without medical advice.

Why can not you even take over-the-counter analgesics without limit?

"It must be clear: pain is a warning signal of the body," says Fölsch. Instead of suppressing complaints with painkillers permanently, it is advisable to get to the root of their causes and to treat them specifically.

If taken too often, analgesics can also cause headaches. Often this leads to a vicious cycle: Since they are unaware of the cause of the headache, those affected try to fight the problems with other painkillers. This particularly affects people who already suffer from migraine or tension headaches. About one to two percent of adult Europeans, according to studies, have a headache from drug overuse.

In addition: Even painkillers available over the counter can have unwanted side effects. Depending on the active substance, they may, among other things, damage the mucous membrane in the stomach and intestine or increase the risk of gastrointestinal bleeding. Other agents put pressure on the liver, kidneys or the cardiovascular system. "With prolonged use, some over-the-counter painkillers even increase the risk of a heart attack or stroke in pre-stressed patients," warns Isenberg. That's why it's worth taking a look at the leaflet.

What applies to children?

"Not every over-the-counter analgesic is suitable for everyone," emphasizes Ursula Sellerberg of the Federal Chamber of Pharmacists in Berlin. Patients should seek advice from their doctor or pharmacy. Pharmacists usually advise against giving children and younger adolescents acetylsalicylic acid (the active ingredient of aspirin) without a doctor's recommendation.

The reason: ASS is suspected to trigger in rare cases, the so-called Reye syndrome. This brain and liver damage, the disease can even be fatal. Ibuprofen, on the other hand, can be dosed correctly and given already to infants.

What should be considered when taking painkillers with other medicines and alcohol at the same time?

It is best for patients to submit their medication plan to the pharmacy if they want to buy a prescription painkiller. "This allows the pharmacist to recognize possible interactions and to assess which over-the-counter painkillers are right for the respective patient," says Sellerberg.

And painkillers and alcohol? "This is a dangerous combination that should best be avoided," says Fölsch.