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Paracetamol is often the first line analgesic recommended, without consensus about which is the better analgesic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An overview review of systematic reviews and meta\u2010analyses directly compares ibuprofen and paracetamol at standard doses in particular painful conditions, or uses indirect comparisons against placebo. Electronic searches for systematic reviews were sought published since 1995 using outcomes approximating to \u226550% pain intensity reduction. Painful conditions were acute post\u2010operative pain, dysmenorrhoea, tension\u2010type headache (<jats:styled-content style=\"fixed-case\">TTH<\/jats:styled-content>), migraine, osteoarthritis and rheumatoid arthritis, back pain, cancer and paediatric pain. There was no systematic assessment of harm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen systematic reviews and four individual patient data meta\u2010analyses were included. Ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions. Two direct comparisons favoured ibuprofen (acute pain, osteoarthritis). Three of four indirect comparisons favoured ibuprofen (acute pain, migraine, osteoarthritis); one showed no difference (TTH), although there were methodological problems. In five pain conditions (dysmenorrhoea, paediatric pain, cancer pain, back pain and rheumatoid arthritis), there were limited data on paracetamol and ibuprofen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At standard doses in different painful conditions, ibuprofen was usually superior producing more patients with the degree of pain relief that patients feel worthwhile. Neither of the drugs will be effective for everyone, and both are needed. This overview questions the practice of routinely using paracetamol as a first line analgesic because there is no good evidence for efficacy of paracetamol in many pain conditions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.649","type":"journal-article","created":{"date-parts":[[2014,12,22]],"date-time":"2014-12-22T09:51:17Z","timestamp":1419241877000},"page":"1213-1223","source":"Crossref","is-referenced-by-count":111,"title":["Overview review: Comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions"],"prefix":"10.1002","volume":"19","author":[{"given":"R.A.","family":"Moore","sequence":"first","affiliation":[{"name":"Pain Research and Nuffield Division of Anaesthetics University of Oxford, The Churchill  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Derry","sequence":"additional","affiliation":[{"name":"Pain Research and Nuffield Division of Anaesthetics University of Oxford, The Churchill  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.J.","family":"Wiffen","sequence":"additional","affiliation":[{"name":"Pain Research and Nuffield Division of Anaesthetics University of Oxford, The Churchill  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Straube","sequence":"additional","affiliation":[{"name":"Division of Preventive Medicine University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.J.","family":"Aldington","sequence":"additional","affiliation":[{"name":"Royal Hampshire County Hospital  Winchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,12,22]]},"reference":[{"key":"e_1_2_9_1_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008392.pub2"},{"key":"e_1_2_9_1_3_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.X200004200"},{"key":"e_1_2_9_1_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004624.pub2"},{"key":"e_1_2_9_1_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu332"},{"key":"e_1_2_9_1_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6977.452"},{"key":"e_1_2_9_1_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1989.tb03273.x"},{"key":"e_1_2_9_1_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-008-0783-x"},{"issue":"3","key":"e_1_2_9_1_9_1","article-title":"Single dose oral ibuprofen for acute postoperative pain in adults","author":"Derry C.","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"e_1_2_9_1_10_1","article-title":"Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults","author":"Derry S.","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_1_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.154047"},{"key":"e_1_2_9_1_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6874-4-5"},{"key":"e_1_2_9_1_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40261-012-0011-7"},{"key":"e_1_2_9_1_14_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1C391"},{"key":"e_1_2_9_1_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-7843.2006.pto_248.x"},{"key":"e_1_2_9_1_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-012-0013-7"},{"key":"e_1_2_9_1_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.14.2093"},{"key":"e_1_2_9_1_18_1","unstructured":"Jadad A.R.(1994).Meta\u2010analysis of randomised clinical trials in pain relief. 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