Key Points
- The ibuprofen + paracetamol combination is generally superior to either agent alone for moderate-to-severe acute pain, particularly well-demonstrated in postoperative dental and surgical pain models.
- The combination achieves a meaningfully better Number Needed to Treat (NNT): ibuprofen 200 mg alone NNT ≈ 3.0, vs. ibuprofen 200 mg + paracetamol 500 mg NNT ≈ 1.6 for 50% pain reduction.
- A dose-sparing effect is demonstrated: lower doses of the combination can match the efficacy of full-dose monotherapy.
- Adverse event (AE) rates are comparable to or lower than monotherapy — the combination does not compound safety risks in short-term use.
- For acute low back pain (non-traumatic, non-radicular), evidence is conflicting: one ED-based RCT found adding paracetamol to ibuprofen provided no additional benefit at one week.
- Both the American Society of Anesthesiologists (ASA) and Enhanced Recovery After Surgery (ERAS) Society guidelines endorse the paracetamol + NSAID combination as part of multimodal analgesia.
