Ibuprofen at 50: The love affair with painkillers

 
Pill on woman's tongue

It is 50 years since ibuprofen was discovered. It has joined aspirin and paracetamol in the special trinity of medicines that people keep close at hand, even when they're well. But have we come to rely on it too much?

You might find it in a red packet in the UK, or a blue packet in the US.

Inside, the silver blister packs promise relief from hangover-induced headaches, the ubiquitous bad back and any number of other ailments.

Ibuprofen has gained a special status since its development in a small test lab in a house in Nottingham in 1961.

Since then it has become a bedrock of pain relief and fever treatment all over the world. As an anti-inflammatory it has been taken by sufferers of osteoarthritis and rheumatoid arthritis, as well as generations of injured sportspeople, professional and amateur.

But unlike most drugs that we get on the recommendation of a doctor, ibuprofen is in that trinity - along with paracetamol and aspirin - that we primarily self-medicate with.

50 years of ibuprofen

Colin Burrows, John Nicholson and Stewart Adams - key figures in the team who developed ibuprofen
  • Discovered in 1961 by Boots pharmacologist Dr Stewart Adams and colleagues, working in a house in Nottingham
  • First clinical trials held in 1966 - launched by Boots as a treatment for rheumatoid arthritis in 1969
  • Available over-the-counter in High Street pharmacies in UK since 1983
  • There are more than 50 forms of ibuprofen, including syrup, tablets, cream, spray, gel, granules and suppositories
  • Available as short-term treatment for acute pain such as headache, dental pain, migraine and period pain
  • Also used to treat conditions such as rheumatoid arthritis and osteoarthritis

These drugs leave us as our own doctors. They have escaped the confines of the pharmacist's shelf and taken up residence in the supermarket, corner shop and all-night garage.

For many people ibuprofen is an essential tool in their bathroom cabinet - as well as featuring in many a handbag and desk drawer around the world.

Stand in an open-plan office and ask loudly for ibuprofen and somebody will have some. For "just in case", more than likely.

But is this a good thing?

Doctor and medical columnist Thomas Stuttaford says he thinks ibuprofen is a reasonable analgesic and anti-inflammatory - but it has more side effects than people realise.

"Side effects include renal damage. It's not terribly well tolerated by the over 65s. It can cause gastric bleeding. And NSAIDs [the group of anti-inflammatory drugs that ibuprofen belongs to] contribute to something in the region of 2,000 deaths a year in the UK."

The risk factors associated with NSAIDs are much discussed but all medicines can potentially cause side effects, and any figures for deaths have to be measured against the vast numbers of people who use ibuprofen without ill-effect. The same calculation has to be made for aspirin.

But some, like Stuttaford, also take issue with the use of ibuprofen as a sort of medical crutch.

He believes that governments have encouraged the use of anti-inflammatories and analgesic drugs like ibuprofen because it cuts down on visits to casualty departments and doctors' surgeries.

Start Quote

It's my belief that it would not get an over-the-counter licence today - but neither would aspirin”

End Quote Dr Chris Wells Pain management consultant

"Advice from doctors used to be 'take two aspirin and call me in the morning'. Now the modern day equivalent is 'take two ibuprofen and call me in the morning'."

Dr Stuttaford says he does not think this is terribly useful.

"Pain is nature's way of telling you something is amiss. I don't approve of over-the-counter patient-directed painkillers - it's much better to get a proper assessment of the pain from a doctor."

Pain management consultant Dr Chris Wells says ibuprofen is a useful drug that helps about a third of people who take it, and reduces their pain by about 50%.

"It is important for a minority of patients with rheumatoid arthritis and osteoarthritis," he says. "It's also a good drug for minor acute injuries, sprained ankles, minor burns, and saves people going to the GP [general practitioner]."

But he also has concerns about ibuprofen and its side effects.

"It's my belief that it would not get an over-the-counter licence today - but neither would aspirin."

He also thinks the overuse of ibuprofen shows that we have lost the confidence to deal with minor aches and pains in our lives without pain relief.

"It's become a pill for all symptoms," he says. "For many people, exercising and weight loss are essential in managing pain, but they are sadly out of fashion."

Dr Stuttaford says our reliance on drugs like ibuprofen goes hand in hand in the UK with the decline in GP services.

"Although we have a much bigger armoury in dealing with health problems, people no longer have a personal relationship with their GPs. They don't know their history, they don't know their mothers and fathers.

"The average allocated time with the doctor is a mere seven minutes. If you're dealing with an octogenarian they might not be able to get their clothes off for a proper examination in seven minutes.

Ibuprofen The tablets have brought relief to millions, but have they helped change our relationship with doctors?

"There's no time to talk. Prescribing them with ibuprofen is one way of shutting them up."

The result? "Many people just bypass the doctors and go straight to the chemists instead."

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, says people will often go to their GPs in pain, and will be prescribed something like ibuprofen that brings some relief.

But what they really need, she says, is to see a consultant rheumatologist, and the use of anti-inflammatories can delay a doctor in making a diagnosis.

"That doesn't mean that they don't play a useful role for some people, and they are important at times, but I sometimes think that doctors don't spell out the risk-benefit scenario.

"You can be taking NSAIDs like ibuprofen for a long time and suddenly get a massive bleed. They are not totally benign."

She says anti-inflammatories such as ibuprofen play a role in managing conditions like rheumatoid arthritis, but that role has changed since new drugs treatments have become available.

Ibuprofen has a following among endurance runners and people playing fast-paced sport such as squash, who use it before or after a big race or match. But many believe the practice is, at best, unwise.

Peter Banister, personal trainer at BSAG fitness in London, says he does not recommend its use.

"People who take painkillers before training or before competing in a big race are inhibiting their body's ability to respond to their environment," he says.

Marathon runners Ibuprofen has a following among marathon runners

"When you are undertaking strenuous exercise you need to be able to react to pain, not mask it."

Banister is not keen on using ibuprofen to try to help relieve muscle soreness after exercise either.

"Research shows that use of anti-inflammatories doesn't actually inhibit muscle soreness and can in fact inhibit muscle growth."

Research into ibuprofen is ongoing, with possible new uses being discovered. In some studies, low doses of ibuprofen over a long period of time were found to be better than a placebo in preventing Alzheimer's disease.

Earlier this year, researchers at Harvard medical school announced that people regularly consuming ibuprofen were reported to have a 38% lower risk of developing Parkinson's disease.

Prof Kim Rainsford, a world authority on ibuprofen, says the beauty of the drug is its chemical simplicity.

"It is handled and metabolised in the body very predictably. It accumulates very well in sites where you need pain relief.

"It's got a very good safety profile, it's got wide acceptance because it does control inflammation as well as the painful symptoms."

Whilst casual overuse of ibuprofen might not be wise, there is no doubting it has provided accessible, effective and well-tolerated pain relief for millions of people around the world.

And it's for that reason it's likely to stay in people's desk drawers and handbags for many years to come.

 

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  • rate this
    0

    Comment number 199.

    194/ Clarence

    casual yes but truth is no one can readily pinpoint what causes Schizophrenia just yet. There was a recent study that found 60% of sufferers used drugs - but are they using drugs to combat the illness or was it the cause? trouble is no one has found out yet

  • rate this
    0

    Comment number 198.

    Clarence, all those studies identify is that some people who have/do smoke cannabis have developed some form of mental illness. If you were to do similar studies but replaced cannabis with alcohol you would get even more frightening results.

  • rate this
    +9

    Comment number 197.

    For everything in this world, probably including water, there are potential side-effects.
    Like so many other issues around today, the culprit appears to be education. I don't know what now has to be taught in schools, and how effectively it's taught. I think that all pupils should attend classes on all drugs, legal and illegal, and their possible effects, as part of the overall curriculum.

  • rate this
    +22

    Comment number 196.

    174- of course as a pharmacist I do not claim to be a 'real doctor', because I am in fact a pharmacist and not a doctor at all. As such I am an expert in medicines and not in diagnosis: that is the job of a doctor. I am happy to advise the public on the treatment of minor ailments; if the symptoms persist or they have any 'alarm bell' symptoms I would always advise them to see their doctor.

  • rate this
    0

    Comment number 195.

    174 june
    I'd rather see someone who knows what they are talking about. Saw a doctor 6 months ago who prescribed for severe indigestion for my stomach pains - a week later, on the advice of my pharmacist, I saw a different doctor who immediately (and correctly) diagnosed gallstones. All had been given exactly the same symptoms

  • rate this
    +4

    Comment number 194.

    Regarding people's comments about the safety of cannabis use - a causal link has been indicated between cannabis use and severe psychiatric conditions in many studies. Some people are ok using it heavily, in the same way some chain smokers get away with living to 100 but it's wrong to think it's a 'safe' drug. http://www.schizophrenia.com/prevention/cannabis.marijuana.schizophrenia.html#can

  • rate this
    0

    Comment number 193.

    I self medicate - I'm I happy about it, of course not. Why do I do it, three letters - N,H.S.

    I tried to list all the medication my "D.R." has me on at the same time for pain management, but there are not enough characters provided to list them all - over 70 pills a day for chronic C.R.P.S. - now that I self medicate I rarely use more than 5 pills a day

  • rate this
    +8

    Comment number 192.

    Yet again a load of doctors insisting that only they know what we should be doing to look after ourselves. More simple medications should be made available over the counter not fewer. Most people are not stupid - they know what works and they can read labels.

  • rate this
    +3

    Comment number 191.

    Like all legal & illegal drugs there will be individuals who are prone to side effects, however for most they allow self treatment & free GPs to attend the patients that need them urgently. If you're worried use a range of painkillers over the day & if the pain doesn't go away then go to your GP.

  • rate this
    +1

    Comment number 190.

    I use all NSAIDs rarely & in small does, and less for discomfort than as anti-inflammatories. Reducing inflammation helps body cure itself. Of course all good things become bad when over-used.

  • rate this
    -1

    Comment number 189.

    Nothing, no matter how harmful, should be proscribed, but there should be a requirement for government to honesty publicise potentially harmful effects.
    That is as far as the nanny state should be allowed to go. Anything further, such as prohibition, causes more harm than good.
    Decriminalising drugs would have a huge beneficial effect.
    NO VICTIM NO CRIME.

  • rate this
    +2

    Comment number 188.

    #181 - yes it is your body and you're entitled to take as many as you want. But health services etc. have a duty to tell you what harm you could do to yourself if you do and they would be the ones treating you.

    Preventing overdoses is cheaper than treating them.

  • rate this
    -1

    Comment number 187.

    I, about once a year, take a particular painkiller purely for a positive side effect. I always take an aspirin (one is sufficient) as well as donning my flight socks before a long haul flight. The side effect of cutting down my risk of developing DVT is something I appreciate (though not as much as the side effect noticed by doctors when researching the original use of Viagra for heart patients).

  • rate this
    +2

    Comment number 186.

    I was in San Marino the other - it is way up in the mountains. I did not dress properly and it was freezing cold. When i returned to mainland Italy i had a throbbing headache which lasted for almost a week and teh shooting pain spread to my jaw. Aspirin did not work but Ibuprofen sorted it out with a day. Thanks Ibuprofen:)

  • rate this
    +40

    Comment number 185.

    A lot of people here are saying that pain is natural, so we shouldn't take painkillers.

    Dying is natural too, but we spend an awful lot of time and money trying to put it off as long as possible.

  • Comment number 184.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    0

    Comment number 183.

    181.neilcherylsimpson
    It IS my body after all, isnt it?

    agree with this completely, as long as you dont harm anyone else it shouldnt matter!

    Also CobaltChicken you make a very good point there

  • rate this
    +2

    Comment number 182.

    I used Aspirin and Ibuprofen as pain relief or an illness (arthritic type) and due to the very high dosage it caused or contributed to stomach ulcers and very painful stomach pains.
    That problem was cured and I am no longer advised to take either.
    More control is required, people often overdose and the damage may not become apparent for years..... by then it is too late

  • rate this
    -1

    Comment number 181.

    @167 Phil Sears

    Surely as an adult in a free country I should be able to buy and take as many painkillers as I like?

    It IS my body after all, isnt it?

  • rate this
    +5

    Comment number 180.

    The "man flu" thing is annoyingly sexist, by the way. I have a filthy cold today and, because I was sneezing and blowing my nose (not complaining about it) I was accused of "manflu" clearly a woman with an equivalent cold would have been too busy to sneeze.

 

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