Paracetamol for Chest Pain
Paracetamol is not an appropriate treatment for chest pain because chest pain requires urgent evaluation to rule out life-threatening cardiac, pulmonary, or vascular causes—not symptomatic analgesic therapy. Treating chest pain with paracetamol without proper diagnosis risks missing acute coronary syndrome, pulmonary embolism, aortic dissection, or other emergencies that require immediate specific interventions to prevent mortality.
Why Paracetamol Should Not Be Used for Chest Pain
Chest Pain Is a Symptom, Not a Diagnosis
- Chest pain demands immediate evaluation for potentially fatal conditions including myocardial infarction, unstable angina, pulmonary embolism, aortic dissection, tension pneumothorax, and pericardial tamponade
- Masking chest pain with analgesics delays diagnosis and appropriate treatment, potentially worsening outcomes and increasing mortality
- The priority is identifying the underlying cause through ECG, cardiac biomarkers, imaging, and clinical assessment—not symptomatic pain relief
Paracetamol's Appropriate Clinical Indications
- Paracetamol is indicated for mild musculoskeletal pain (NRS <3/10), osteoarthritis pain, headache, and fever—not for undifferentiated chest pain 1
- It is effective for mild to moderate pain arising from non-cardiac, non-emergent conditions when the diagnosis is established 1, 2, 3
- Paracetamol provides analgesia through central nervous system mechanisms, not by addressing cardiac ischemia, inflammation, or other chest pain etiologies 4, 3
When Paracetamol Might Be Considered (After Diagnosis)
Musculoskeletal Chest Wall Pain
- After cardiac and pulmonary causes are excluded, paracetamol 1000 mg every 6 hours (maximum 4 g/24 hours) may be appropriate for costochondritis or chest wall strain 5, 2
- If inadequate relief after 24-48 hours, add an NSAID (ibuprofen 400 mg every 6-8 hours) rather than exceeding paracetamol maximum dose 5, 2
Cancer-Related Chest Pain
- For mild cancer pain (NRS <3/10) involving the chest wall, paracetamol is first-line therapy per WHO analgesic ladder 1
- For moderate to severe cancer pain (NRS >6/10), strong opioids plus paracetamol are indicated, not paracetamol alone 1
Critical Pitfalls to Avoid
- Never use paracetamol as initial treatment for new-onset chest pain without excluding cardiac ischemia, pulmonary embolism, and aortic pathology
- Never assume chest pain is "just musculoskeletal" without proper evaluation—this assumption can be fatal
- Do not exceed 4 g/24 hours of paracetamol (3 g/24 hours in chronic use, elderly, or liver disease) to avoid hepatotoxicity 2, 6
- Do not delay emergency evaluation by attempting home treatment with over-the-counter analgesics for chest pain
The Correct Approach to Chest Pain
Chest pain requires immediate medical evaluation, not analgesic therapy. The focus must be on identifying and treating the underlying cause—whether that requires antiplatelet agents and revascularization for acute coronary syndrome, anticoagulation for pulmonary embolism, or other specific interventions. Only after life-threatening causes are excluded and a benign diagnosis (such as musculoskeletal pain) is confirmed can paracetamol be considered as part of symptomatic management.