Keeping a packet of paracetamol handy in the bathroom cabinet might seem the safest and most convenient way to tackle pain.
After all, it's free from the stomach damaging side-effects of other painkillers, such as aspirin and ibuprofen.
However, evidence is mounting to show that not only does paracetamol cause this kind of damage after all, but the 'everyday' drug may also harm us in many other serious ways.
Indeed, far from being the risk-free panacea so many of us believe it to be, a growing weight of evidence from studies conducted
across the world links the drug to a number of very serious side- effects.
These include asthma and developmental defects, such as attention-deficit hyperactivity disorder (ADHD) in children, as well as potentially lethal heart and kidney problems in adults, and even a risk of death from rare, but excruciating, skin reactions.
The evidence has prompted drug watchdogs in Britain and America to warn doctors against routinely prescribing paracetamol.
But this has ignited a row with medical professionals who feel that without it in their medicine bags, they will have nothing with which to treat millions of patients.
Meanwhile, there are also suggestions that for some ailments, the drug is, in fact, no better than a placebo.
A PLACEBO WORKED JUST AS WELL FOR BACK PAIN
Paracetamol has, until now, been regarded as especially helpful for those who cannot take painkilling non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
They may be allergic to NSAIDs or be on medication that interacts dangerously with them, such as blood pressure pills or steroids. Other patients may have stomach ulcers or bleeding disorders, which can be worsened by NSAIDs.The latest question over paracetamol was raised by a study published in The Lancet last month, which found that the drug is no better than a placebo for lower back pain.
IS IT SAFE FOR PREGNANT WOMEN?
Over recent months, other evidence has emerged that should make us wary of using paracetamol as a first resort when feeling pain. In February, a report in the respected journal JAMA Pediatrics warned that children born to women who used the painkiller during pregnancy may have an increased risk of ADHD and other behavioral problems. Paracetamol 'is the preferred choice' to treat mild or moderate pain in pregnant women, according to NHS Choices.
The guidance adds: 'There is no clear evidence that it has any harmful effects on the unborn baby.' However, this is disputed by researchers who studied 64,000 pregnant Danish mothers and their children born between 1996 and 2002. At each trimester of pregnancy, they asked the mothers if they had taken any paracetamol in the previous three months.
When the children were seven, researchers asked the mothers about their child's behavioural patterns and whether they had been put on the ADHD drug Ritalin. They found that pregnant mothers' paracetamol use was associated with an almost doubled risk of ADHD and other hyperactivity- related disorders.
The strongest effect was in women who took the painkillers during all three trimesters, regardless of how many they took. Women who reported use for a minimum of one week still had an increased risk.
'We really have to be more careful about what pregnant women put into their bodies - even substances we think are harmless or safe may not be,' says the study's author Dr Beate Ritz, a professor of epidemiology at the University of California.
'Expectant mothers should think twice before medicating a slight headache or fever.' Instead, researchers suggest mothers try relaxation techniques that may reduce their sensitivity to pain. The results reinforce concerns raised by the Norwegian Institute of
Public Health last year. Its study of 3,000 pairs of siblings found that those exposed to paracetamol in the womb for more than 28 days of pregnancy had poorer physical co-ordination and communication skills and more
behavioral problems compared with their unexposed brothers or sisters.
'We have also found that women who say they took paracetamol regularly while pregnant have children who are more likely to develop asthma' - Seif Shaheen, professor of respiratory epidemiology at Barts and the London School of Medicine Seif Shaheen, professor of respiratory epidemiology at Barts and the London School of Medicine, says there are also worries that paracetamol may raise the risk of children developing asthma.
He explains: 'We first discovered the possible link in 2000, when we were worried about lab studies on animals, which had indicated that paracetamol may deplete the levels of an antioxidant called glutathione in the lungs.' This antioxidant seems to stop the inflammation in the lungs that can restrict airways and cause asthma. 'Since our first study of mothers and children indicated this may be
a problem, another 20 studies worldwide found similar links,' he says.
'We have also found that women who say they took paracetamol regularly while pregnant have children who are more likely to develop asthma.' All these studies, however, have been retrospective. They asked people how many times they remember taking paracetamol in the
past. This is not precise enough to say conclusively that paracetamol can cause asthma.
THE LINK TO HEART FAILURE
But other concerns about the drug led the UK's treatment effectiveness watchdog, the National Institute for Health and Care Excellence (NICE), to issue draft guidance earlier this year warning GPs against prescribing paracetamol to patients with osteoarthritis, who can take the drug regularly for years on end.
'Any patient who develops a skin rash or reaction while using paracetamol should stop the drug and seek urgent medical attention right away.'
Other American research has linked long-term use of paracetamol with blood cancer.
In one study of nearly 65,000 people, taking paracetamol for at least four days a week for four years was linked to nearly double the risk of being diagnosed with leukaemia or lymphoma.
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