> But if acetaminophen is safer, then why don’t official sources tell you that?
Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution.
[1]: https://www.dmp.no/nyheter/behov-for-smertestillende-slik-ve...
[2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
I feel like this is one of those things where Europe and the US are very different, culturally speaking - I've lived in the Netherlands, Germany and now Sweden, and the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
I've taken so much Advil/Ibuprofen in my life it would be impossible to count at this point.
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
Have you tried to have this diagnosed?
You're forgetting that when you're sick and hurt yourself in the US you very likely still have to go to work. Doing some quick research, roughly 25% of the US workers don't have any sick time whatsoever, so you gotta take some painkillers and get back to work. If you need to take time off to go to the doctor, you're no longer getting paid, so...a lot of people don't do that and instead hide the pain with painkillers.
Reckon you've just summed up the US health care system to a tee.
Harder, faster, stronger, smarter
Well for one thing, in America, you gotta get back to work.
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
Yeah I think this is the biggest difference. Here in Sweden if I get a headache that's bad enough I'll just take a sick day and there's not really much social stigma about that kind of behaviour unless it becomes a pattern that you don't seek medical help for.
AIUI one of the many quirks of the US health insurance system is that a lot of people have only minimal cover which doesn't include things like physiotherapy and rehabilitation treatment. That means that they often can't treat a painful condition at source so their only option is to mask the pain with painkillers.
It's worse than that - there is also no job protection. Hurt yourself and miss a few days of work and you are possibly unemployed on top of injured. And then you lose your health insurance, so you can no longer get/afford any treatment.
I'm convinced it's designed this way on purpose. Can't have people relaxing, ever. Must extract every ounce of productivity and blood while they're alive.
This is so absurd to me. The expression "prevention is better than cure" isn't just folk wisdom, in just about any country with nationalized healthcare the studies also confirm that this costs less money. The only exception I ever heard was a Dutch study in the 2000s suggesting that people growing older due to smoking less was going to increase healthcare costs, because people were getting older putting pressure on the pension system, but let's not peer further into that can of worms.
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
> unless they have ways to externalize the costs onto the rest of society
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
[dead]
> That's also healthier in the long run, no?
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
Maybe you took carprofen?
Since we're talking about acetaminophen and ibuprofen, in France you're liable to end up with a medicine cabinet full of acetaminophen, because almost anytime you go to the doctor with any type of pain, they add it to the prescription.
Interesting, in the US they often do that too but I’ve personally never filled it because insurance doesn’t cover over the counter medications. So I’d have to pay cash for it.
Does acetaminophen require a prescription in France?
>Pain a warning signal from the body
Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.
> the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.
Americans' relationship with painkillers is absolutely unhinged.
Might just be an artifact of the broken healthcare system. Painkillers are cheap and over the-counter. Going to a doctor is not.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work.
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
Yup exactly, that's what I was getting at. In the US you can't afford to _not_ work. Not to mention that if you do have actual longer-term health concerns, you also need to pay for the actual treatment, and your insurance depends on your employer. The entire system is really quite flawed.
>Like I just mentioned in another comment, they're also a way to get you back to work ASAP. Just about everyone NOT working a comfy white collar office job needs to be working in order to make money. Time off is less income, people can't afford that so they do what they need to do to get back to work. >Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
The office workers will just pop the same damn pills and show up too. Office workers are more likely to show up when in pain specifically because their job doesn't aggravate it. Most people don't have a lavish BigCo sick time policy and even if they do why burn sick time just to be in the same pain and pop the same pills at home. Most people will just have to work harder to make up for being out anyway. It makes sense to just be in pain at the office.
> home-made oral rehydration solution
water?
EDIT: I see it's a thing. Salt, water and sugar.
Apologies, I could have clarified that (then again my comment already was a wall of text).
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
However, that is in the context of oral rehydration therapy:glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
The reason for doubling the amount of sugar is that the active absorption of water relies on glucose, while regular sugar is made out of sucrose. Sucrose breaks down into equal parts fructose and glucose (both have identical chemical formulas but a different arrangement of the atoms).[0] https://en.wikipedia.org/wiki/Oral_rehydration_therapy
[1] https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote...
[2] https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1 page 12 of the linked on that page (labeled as page 3)
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
None of this is in disagreement with my argument and comes across as actively ignoring the part where I explain that I am not advocating to "walk it off".
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
Perdue Pharma/The Sacklers went on a huge campaign in the 90s convincing doctors and the general public that pain was bad and worth stopping at any cost and even though they were pushing opioids, I can imagine this also increased the cultural tendency to use NSAIDs as well.
I agree that Purdue Pharma was probably the most significant factor, maybe enhanced by the relative ease of granular lobbying of private doctors as compared to the challenges it may face in universal healthcare systems. However, I do suspect that the limited rights of most US workers to take sick leave served as one more cultural advantage in favour of Purdue's campaign.
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
Weren't the Perdue Pharma products sold in combination with Acetaminophen?
My assumption was this was always required to get regulatory approval to make abuse have harsher side effects. Liver toxicity of acetaminophen is pretty bad compared opioid abuse from what I understand
> Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
> It's no more rational than the human mind
Neither is a car, but I still take it to get checked out when a warning light is on.
> Neither is a car, but I still take it to get checked out when a warning light is on.
I can't believe I need to say this, but cars did not evolve by natural selection. Cars are intelligently designed (by humans, not by God) to show a warning light when there is a problem you should get checked out. So cars are actually rational in that respect.
Hacker News comments never fail to depress me.
> I can't believe I need to say this, but cars did not evolve by natural selection.
You didn't need to say that because that's not relevant. The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
> Hacker News comments never fail to depress me.
That's also a signal.
> The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
I know otherwise. I have a lifetime of experience—lifetimes of experience, counting the experiences of other people—to know that pain is often just noise.
Pain is ancient. It predates rationality by millions of years, perhaps billions. The dumbest animal experiences pain. It's not a finely tuned system with documented diagnositic codes.
Especially if a new one, pain is undoubtedly a 'warning signal from the body' which is a succinct metaphor we all understand and has a clear meaning. If you don't know why or from whence the pain, check it out. It may be one of those things or perhaps not.
The previous commenter appears to argue that you need to diagnose every headache, which sounds absurd to me.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
Thank you, I share this sentiment but couldn’t quite put it into words. Sometimes it isn’t that deep.
Yup - in the UK, paracetamol is usually recommended for general pain relief before Ibuprofen. Additionally, Ibuprofen and NSAIDs have a lot of interactions which can make them unsafe - SSRIs or blood thinners for example.
Ibuprofen interacts with SSRIs? Anecdotally I've never had any problems with my Escitalopram and the Wikipedia page doesn't mention any interactions
Where does Aspirin fit into this? I only use paracetemol and ibuprofen. The one time I tried asprin I got a stomach pain.
aspirin is an NSAID, taking it modifies the prostaglandine levels (through its COX inhibition) and this influences the mucosa of your stomach. ibuprofen can still have the same side effects, because its belonging to the same class of drugs.
Here in my body, it tells me acetaminophen does absolutely nothing for pain where as ibuprofen does. I wouldn't take ibuprofen for fever
I once got it to make a small difference for pain - but I was in the hospital (surgery recovery) where the doctors were giving me more than the daily maximum.
This might sound like woo, but sometimes I'll find a quiet place and just sit there and focus on the pain. I try to really understand the sensation that's being registered as pain by trying to notice all the properties of it (is it throbbing, burning, etc...).
Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
American in Norway, it's always amusing when I buy some Ibux at the pharmacy, and get questioned about it and steered towards Paracet instead.
They do in NZ. Paracetamol is promoted as the safest, most well studied pain relief for short and chronic conditions. In Australia however they have just started limiting how many you can buy at a time for some reason while ibuprofen covers the chemist shelves without any such controls despite the risks.
It’s the same in the UK - paracetamol is the default. Ibuprofen is better for reducing swelling, inflammation etc.
Ibuprofen is better are reducing fever and managing headaches.
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
Wiki for phenacetin says it's mechanism of action is being metabolized into paracetamol. IDK about your "nowhere as effective".
It was withdrawn for sometimes being metabolized into another, toxic and carcenogenic, molecule.
Here is a summary of COCHRANE evidence on Paracetamol "widely used and ineffective"[0].
It's a paradox no?
Paracetamol is only the presumed only active metabolite, and that is why paracetamol rapidly replaced phenacetin.
There is a quirk though, phenacetin actually delivers paracetamol to your brain and spine (where it primarily reduces pain) faster than an oral dose of paracetamol.
Similarly IV paracetamol is far more effective that oral paracetamol.
Phenacetin was also considered mildly addictive, and induced a gentle euphoria and then sedation.(We still see sedation after paracetamol in children and the elderly). But general use we don't see these effects in paracetamol, why did phenacetin do this more effectively? Probably the higher peak levels around nerve endings.
These effects are both wanting of an explanation of phenacetin is just paracetamol and directly analegisic.
[0] https://web.archive.org/web/20240721144157/http://www.eviden...
Interesting.
I guess it tracks with personal experience. I find Paracetamol is OK for fevers/generic cold symptoms but absolutely useless for a headache, Ibuprofen is the only thing that shifts them.
Well it's the only thing that shifts them now I'm in a country where I can't buy soluble aspirin and codeine OTC.
I end up using paracetamol often for pain because it's what's to hand.
What annoys me is that so many people have your experience and are effectively gaslit about the fact it seems to often perform so poorly.
Reminder: don't take medical advice from someone who can't write correctly.
Very interesting though that the original article makes no comment on efficacy. It's all about metabolic safety which is not contentious.
Same in Portugal.
In Western Europe too.
> but it does absolutely nothing with actual pain. It is placebo at best.
This is simply false.
you responded to the wrong comment. I assume this want mean for https://news.ycombinator.com/item?id=47860061
It is not false. It does nothing. Head hurts, you take paracetamol ... head still hurts. The belly hurts, you take paracetamol ... nothing change.
When I took ibuprofen it did actually made an actual real change.
"I took it and it didn't work so it's a fake placebo drug" - wow, your scientific method is flawless, have you considered a career at the US Department of Health?
Guideline #1 for comments-
Be kind. Don't be snarky. Converse curiously; don't cross-examine. Edit out swipes.
That might be a good fit considering who's in charge today.
Maybe you had an inflammation-induced pain. That would explain why ibuprofen helped, and paracetamol did not.
I have a counter-study with size n=1: I did all my recovery from tonsilectomy on paracetamol and definitely noticed it working. That was however on the maximum safe dose.
(one of the major problems with paracetamol is that the effective dose is only a few multiples away from the dose which starts to cause liver damage! It is by a long way the most dangerous OTC drug)
You're partially right compared to placebo only about 5% of people are painfree over the effect of a placebo when taking paracetamol.
Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin.
Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
Where did you pull this 5% from? There are gazillions of studies showing higher or lower efficacies for different kinds of pain. Along with the inaccuracies about Phenacetin (whose MOA is metabolising into paracetamol).
You will indeed find various figures for various pain types all are far worse than ibuprofen.
Here is an example from the Cochrane library
> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.
A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.
The NNT of 22 gives 1/22= 4.5%.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
"pain free" is a long way from the pain is manageable. Pain is an understudied subject, where we have too little knowledge. Just using the word manageable is an indication of this.
That's very true, but the metric is applied to all medications you compare against that's what's important. You also just get a baseline idea of what's good by guessing what you'd accept.
Episodic tension type headache tested with ibuprofen Vs placebo NNT is 14. (Btw that's not great itself) But it's better than paracetamols often quoted figure 20.
Here's why I say it's not great. Why don't you guess some reasonable NNTs for say moderate depression treated with SSRIs, or no relapse in schizophrenia treated with an antipsychotic. Now guess the NNT for a statin to prevent a first heart attack.
SSRI for moderate depression about 10, antipsychotics to prevent schizophrenia relapse over 2 years NNT= 3 (excellent )Statin to prevent a first heart attack 200! (This one always shocks me). Statins have a clear role of course.
[0] https://thennt.com/nnt/ibuprofen-treatment-episodic-tension-...
In Ireland you can buy acetaminophen in stores, gas stations etc.
For ibuprofen you need to go to a pharmacy.
I couldn't get over this after moving here from the UK where you can pick up a pack for 10p in a supermarket.
That is interesting. In the UK they're both available pretty much everywhere, and they're some of the cheapest drug prices I've seen anywhere in the world... ~20p for 16 tablets or something.
Really? I get headaches semi-frequently and my first line of defense is ibuprofen, I use acetaminophen sporadically as a last resort
Why? Does ibuprofen work better? It's bad for your stomach walls.
> Does ibuprofen work better?
In my experience it works far better at managing headaches/migraines.
I take both. 500-1000mg acetaminophen, 200-400mg ibuprofen. Usually helps for headaches which I get frequently. I only take them for the worst headaches though, so probably once every couple of weeks on average.
Yeah if I need to I take both also. In addition I be sure to have a caffeinated drink also as caffeine has been shown to both speed the absorption and boost the efficacy (5-10%) of paracetemol over a multi hour period. https://pubmed.ncbi.nlm.nih.gov/17442681/
perhaps it's got to do with packaging sizes. i think an acetominophen od is much worse. most of these countries regulate package size for these drugs, yes? US does not
Same in France
The only issue with treating pain with paracetamol is that it does not work at all against the pain.
It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.
> but it does absolutely nothing with actual pain
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
Yeah paracetamol does absolutely nothing to me with pain. I thought its mainly fever medicine.
Same here. Paracetamol also gives me pretty strong stomach aches whereas ibuprofen rarely has a gastric effect and when it does it's mild at best. I've been told by many people that the opposite should be true but oh well.
I wish they dipyrone was sold here, but alas I can only get it when I travel abroad.
With medicine both can be true, the response depends on so many factors in your body. Same way that for some people, particularly those with ADHD, taking stimulants can make them sleepy.
Yeah, for me paracetamol is worse in everything - fever, pain, etc.
For mild stuff I use ibuprofen, if it gets worse, diclofenac works every time.
Many years ago I had 4 surgical procedures done around my nose/throat at the same time - straightening a deviated septum, turbinectomy, enlarging the openings into my sinuses and removing my tonsils. This meant I couldn't breath through my nose for about a month - and breathing through your mouth when you've just had tonsils removed is quite painful.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Your statements are factually incorrect.
Double blind placebo controlled trials have shown that acetaminophen/paracetamol is superior to a placebo at controlling pain.
It may not work for you, I don't know. But it absolutely does work in general!
What is actual pain?
When it hurts. Like, when your head hurts for example.
And if it stops the hurt - does it stop the actual pain?
Yes, but the thing causing the pain may still be there