Paracetamol for Mild Stomach Ache
For a patient with mild abdominal pain, paracetamol is the clear first choice among these three options. 1
Why Paracetamol is Preferred
Paracetamol has virtually no gastrointestinal ulcerogenic potential and does not damage the gastric mucosa, making it uniquely suitable when the pain is already originating from the gastrointestinal tract. 2, 3 Unlike NSAIDs, paracetamol does not alter the gastric mucosal barrier to hydrogen ions, does not lower gastric potential difference, and does not cause surface epithelial cell damage or microerosions. 4
Key Safety Advantages in Abdominal Pain:
- No association with gastrointestinal bleeding or ulceration at recommended doses (≤4g/24 hours), whereas both ibuprofen and diclofenac carry significant GI toxicity risk. 2, 3
- Does not increase fecal occult blood loss, unlike NSAIDs which commonly cause this problem. 4
- Safe in patients with existing gastric irritation or ulcer risk, making it the only appropriate choice when the source of pain may be GI-related. 3, 5
Why to Avoid NSAIDs (Ibuprofen and Diclofenac) for Stomach Pain
Both ibuprofen and diclofenac can worsen abdominal pain by causing gastric erosions, ulcers, and bleeding. 6
- Ibuprofen, despite being the lowest-risk NSAID for GI complications, still produces erythema, erosions, and occasionally ulcers with short-term use. 3
- Diclofenac carries intermediate GI risk—higher than ibuprofen but lower than high-risk NSAIDs. 6
- NSAIDs dramatically reduce gastric mucosal protective prostaglandins, compromising the stomach's natural defense mechanisms. 4
Dosing Recommendation
Start with paracetamol 1000mg every 6 hours (maximum 4g/24 hours). 1 This provides effective analgesia for mild pain while maintaining the superior safety profile. 6
Critical Pitfall to Avoid
Never use NSAIDs as first-line therapy for abdominal pain. The stomach ache itself may represent early gastric irritation, peptic ulcer disease, or gastritis—conditions that NSAIDs would directly exacerbate. 3, 4 Using an NSAID could mask worsening pathology while simultaneously causing additional mucosal damage.
When to Escalate
If paracetamol at maximum dose (4g/24 hours) fails to control the pain after 24-48 hours, this warrants clinical evaluation to identify the underlying cause of abdominal pain rather than escalating to NSAIDs. 1 Persistent abdominal pain requires diagnostic assessment, not simply stronger analgesics that could worsen potential GI pathology.