https://www.science.org/doi/10.1126/scitranslmed.abj9954

After a recent trip to Europe to visit my father, I was reminded of some strong cultural differences on how we approach many different aspects of life, and in this particular instance, whether or not you view medication as mostly beneficial or something to avoid whenever possible.

In this instance the discussion centered around over-the-counter pain medication, which 1 of my family members was trying to ration pretty drastically even when facing some pretty gruesome background pain associated with transient medical treatment (frankly more drastically than I would have done under the same circumstances). This struck me since I had just been catching up on some recently published research during my 15 hour plane ride, and had a couple touchy discussions just prior to my departure with some patients who I felt were overusing Tylenol and ibuprofen into potentially harmful ranges.

Compared to other countries,the US average population reaches for over-the-counter pain medication much more readily than other counterparts around the world. Part of it is because culturally we tend to have a lower threshold for what we consider as acceptable pain, and for the fact that we consider all pain as being of no benefit and needing to be silenced at all costs. There is also a strong bias for the benefit of pain medication and a strong bias against recognizing the side effects of those medications, especially if taken within the maximal safe limits listed on the label. This is really unfortunate because the maximum safe dose listed on a bottle of ibuprofen or acetaminophen does not mean that it's safe for everyone under all circumstances, and it's definitely not to indicate that those doses are safe to take on continuously, which is what a lot of people do on a daily basis. (An acquaintance I know who's a nephrologist jokes that Tylenol pays his mortgage, since it causes so much renal failure even in moderate doses)

Another dark side of ibuprofen in particular, and actually all NSAIDs, is that they are involved in perpetuating a chronic inflammation cycle, and thus delaying recovery from an acute painful episode, possibly setting up the stage for chronic low-grade pain. This article is certainly pretty technical, but but it boils down to this: the chemistry of early inflammation that causes pain triggers a secondary response to then downward modulate that very initial inflammatory response, leading to decreased pain. If you significantly interfere with that initial inflammatory neutrophil response by doing such things as using ibuprofen, you run the risk of aborting the secondary downward modulation.

This is not to say that there's never a time and a place to use ibuprofen, but it should be done so very sparingly, and primarily as a short-term pain management when patients cannot manage some essential tasks through an acute episode. I see a lot of people who routinely start taking large amounts of ibuprofen at the very onset of a mild to moderate episode under the flawed understanding that it will be beneficial to dampen inflammation, when they are better nonpharmacological alternatives that do not interfere with the normal resolution of pain and inflammation.