Pain management with paracetamol and ibuprofen in combination

Abstract

Introduction: Pain is not limited to the activation of nociceptors but it is also influenced by psychological and physical factors through imbalance between inhibitory and stimulatory pathways. Methods: Medical literature about the physiopathology and treatment of pain, with a particular focus on mechanical and inflammatory musculoskeletal pain, was reviewed and combined with the expert opinion of the author. Results: Analgesic therapy that combines drugs with different mechanisms of action can increase the efficacy while de- creasing the side effects. Several studies have shown that the combination of paracetamol and ibuprofen (resulting in a cen- tral analgesic and a peripheral anti-inflammatory action) provides superior efficacy and better safety profile than separate drugs. In 2019 a board of experts recommended this combination as the most suitable in treating mild-moderate musculo- skeletal pain. Paracetamol/Ibuprofen combination is also indicated in musculoskeletal inflammatory pain associated and worsened by muscle contraction, like low back pain, chronic joint pain, osteoarthritis, tendinopathy due to rotator cuff syndrome; the combination is able to counteract both the inflammatory process and the descending stimulatory pathway. Conclusions: The combination of paracetamol and ibuprofen shows efficacy and tolerability in different types of pain and is indicated as a first-line analgesic treatment in various morbid conditions. Keywords: Pain treatment, musculoskeletal pain, ibuprofen, paracetamol