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Comment by derefr | Hacker News Reader

They didn’t say opioids are no better than either acetaminophen or ibuprofen; they said that opioids are no better than the combination of ibuprofen with acetaminophen — something very rarely prescribed (and usually advised against on the labels of both drugs.)

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counter-anecdote: my doctor told me to use precisely that combination for severe pain. She said you cannot combine multiple NSAID's (ibuprofen, naproxen, ASA), but you can combine an NSAID with acetaminophen.

Same. In the hospital I was given small doses of morphine, and frankly I was shocked at how well it worked. I've had demerol for kidney stones, and it didn't do much for pain.

But the morphine at the hospital was like magic. And the dose low enough I didn't really feel any other effects.

That said, when it was time for discharge, the doc told me to alternate tylenol and advil every 2 hours (4 hour cycles each), as needed.

It wasn't news to me. I've followed the protocol before. I wasn't really in much pain by the time I was discharged, so I didn't bother with it this time and can't really compare.

Agreed; I've been prescribed that combination more than once by different doctors. It's very common, and often the recommendation is to stagger them. NSAIDs are metabolized by the kidneys and acetaminophen is metabolized by the liver, so they can be safely combined.

EDIT: also, this is pretty much what Excedrin is (aspirin instead of ibuprofen, but NSAID + acetaminophen, plus also caffeine)

As a migrainer, excedrin really only works part of the time. Though, opioids really only succeed in making me not care about the pain. I’m still in pain with them.

The best treatments, for me, directly address whatever underlying issue.

Drifting off-topic, but have you tried sumatriptan ("Imitrex")? It seems to have a near-total effectiveness on my ~monthly migraines. Neither acetaminophen nor NSAIDs ever did anything for my migraines.

I agree that directly addressing underlying causes like stress, noise, sleep, and diet are better than a pill.

I was about to say the same thing - sumatriptan works amazingly well for my migraines. I'm in the UK though, and I seem to recall someone on HN saying it was very expensive in the US.

It might have once been expensive ("Imitrex" (R)(TM)) but there is a generic now. I understand there are also non-pill delivery systems, like nasal or patches, and other permutations that may still be under patent. The pills seem to work for me.

Triptans work for me as well, but they’re too hard on my body. It’s aftually pretty scary how they work.

Can I ask what side effects it is you get? Just curious since there don't appear to be any negative effects at all for me.

It works by causing your muscles tissues to dialate or something like that. My doctor explained taking too many in too short a time could cause a stroke or heart attack, forget which exactly. One side effect i get is my skin becoming highly sensitive to heat. We’re talking luke warm shower water feeling something like scalding hot. It’s not that exactly either, very weird sensation. Other times my throats tensed up similar to when you eat something highly sour.

We do this pretty often for the patients that come into our student run clinic. We aren't allowed to prescribe opioids, so we tell them to alternate ibuprofen and acetaminophen every 4 hours. Works pretty well, and doesn't stress your liver or stomach as hard.

I take that for every tension headache (which isn't often, I mostly get migraines and clusters): 3 ibuprofen and 2 tylenol.

I had no idea the labels said otherwise.

I believe the study, but I've also taken opioids for pain and for me personally there's no comparison. Not even close. Placebo?

They didn't say opioids are no better than acetaminophen+ibuprofen, but codeine, which is weak enough to be freely available OTC in many countries.

Anyone doubting the merits of opioids in pain control should take a look at https://en.wikipedia.org/wiki/Equianalgesic - many of the voices in this debate will sorely regret their remarks if they ever experience real pain, which most people will at some point.

Acetaminophen and ibuprofen are safe and effective together.

The label you refer to advises against using other medicines that contain acetaminophen, as many cold and allergy medicines do (Excedrin, NyQuil, Robitussin).

The thing you want to look out for are not doubling up acetaminophen, and not taking any combination of aspirin + naproxen + ibuprofen.

NSAIDS + acetaminophen are very common. Excedrin is acetaminophen + aspirin (and caffeine).

>and usually advised against on the labels of both drugs.

I've never seen this.

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