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Pain & Fever Management

4 min read

Ibuprofen, acetaminophen (paracetamol) and aspirin are the core pain and fever medicines, and each has a situation in which it is the wrong choice, while opioids and local anaesthetics are stronger tools that need much more care. Acetaminophen is the one most likely to kill quietly: an overdose causes no obvious symptoms for about a day and then liver failure, and it is hidden in many combination products. No doses are given here.

Part of Critical Drugs to Prioritize

Pain and fever medicines are the commonest finds and the commonest cause of accidental harm.

Know Which Drug Does What

  • Ibuprofen (Advil, Motrin). An anti-inflammatory that eases pain and fever. It is usually taken with food. Avoid it with kidney problems, a history of stomach ulcers or bleeding, and while dehydrated from vomiting or diarrhoea, since it can strain the kidneys. Some people with asthma react to it.
  • Acetaminophen (paracetamol, Tylenol). Eases pain and fever without reducing inflammation. The danger is the liver. It is present in many combination cold, flu and pain products, so two products can quietly add up to an overdose. Heavy alcohol use and existing liver disease raise the risk.
  • Aspirin. Pain, fever and inflammation, and it thins the blood. It has a recognised role in suspected heart attack, but the amount and the exclusions (bleeding, allergy) belong to a reference. It should not be given to children or teenagers recovering from a viral illness because of the risk of Reye’s syndrome, a rare but serious brain and liver condition; check the package for the age guidance, which this article does not specify.

For fever itself, which is often a sign of the body fighting infection rather than a problem to eliminate, see Fever Management.

Stronger Options Need More Care

  • Tramadol and codeine. Opioid pain relievers for moderate pain; codeine also suppresses cough. Both slow breathing at high amounts, and tramadol can cause seizures and interact badly with some antidepressants.
  • Hydrocodone and oxycodone. Strong opioids. Reserve them for severe pain from genuine injury; they are habit-forming and can stop breathing.
  • Lidocaine. A local anaesthetic used for wound repair, dental work and minor procedures, in injectable and topical forms. Too much, or injection into a blood vessel, can cause seizures and heart rhythm problems.

Method: Safer Use Without Doses

Step 1: Identify every active ingredient. Read the label, and for combination products list each ingredient.

Step 2: Match the drug to the person. Check the cautions above against the person’s history: kidney, stomach, liver, asthma, alcohol use, pregnancy and any other medicines.

Step 3: Do not combine without knowing. Sedating drugs, alcohol, opioids and sedating antihistamines add together.

Step 4: Take the amount and the limit from a reference. Not from memory and not by guesswork.

Step 5: Plan for an overdose. Know the signs and where help is. See below.

Common Mistakes

  • Doubling up with a combination product. The same ingredient hides in more than one tablet.
  • Waiting for symptoms after a suspected acetaminophen overdose. They do not appear for about a day.
  • Using ibuprofen while dehydrated. It can harm the kidneys.

Safety

Acetaminophen overdose looks fine for a day and can then be fatal

A person who has taken too much acetaminophen often has no symptoms at first, then develops liver failure. Waiting for symptoms means waiting until damage is under way. If you suspect an overdose, treat it as an emergency even if the person feels well. Opioid overdose causes slow, shallow breathing and unresponsiveness; place the person in the recovery position, keep the airway open and seek help. No dose is given here.

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