This isn't a scientific take necessarily, but did those studies look at the overall time of resolution of the illness and severity of the fever and related symptoms as well as the activity level of the patients?
Because for me, significant fever is always accompanied by some degree of malaise. Without drugs, the only way to relieve it is to conserve energy and immobilize.
My thought is that if you take the pain reliever so that you feel better and are able to do another task then this will likely increase the time needed to recover, since the body is not able to focus as much of it's resources on the immune system while you are doing something else.
If you take a pain reliever and it allows you to rest more effectively than you would be able to without it, maybe that would actually benefit the immune system though.
I’m pretty much certain that 8-9hrs of sleep per night with a fever reducer and/or decongestant and a little bit of weed is gonna get me better faster than no drugs and getting three or fewer hours of sleep multiple nights in a row.
When illnesses get really bad for me it’s usually because they’ve only let me sleep like five total hours in three nights or something like that, due to fever chills or lots of snot and a very-sore throat. The lack of sleep is what wrecks me.
Shift sleeping with a few hours of overlap, and one sleep-in day each on the weekends, meant this was never a major problem for us (three kids). We were getting 7ish most nights even in the worst months (which was really only the first three or so)
I am disappointed by the results here as I do feel fever helps me a lot.
I need fever when I’m sick. I can feel my body as in a faulty state. It makes me rest, no matter what my brain says. It makes me think twice what I eat. I hold it for few days without any problem - yet i take these drugs if fever is too high o lasting too long (in this case the cause of the illness must be addressed urgently).
Why would you be disappointed with the results? The question was whether there's a medical need to avoid fever-reducing drugs, the answer is no. But as the article states there's also no harm in avoiding them:
> The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen.
This was asked on ELI5 on Reddit recently and the consensus seemed to be that fever take’s collateral damage, and all the modern niceties, like ample access to guide, food and a warm bed makes fever less relevant in curing infections.
The article quotes some studies done on critically ill patients and looked at the mortality rate, but I feel like expecting ibuprofen to prevent death or get patients out of the ICU is too far-fetched. I wonder about the effect on illnesses like the flu and whether a fever reduces the time needed to recover.
I feel like this covers that problem, no? Surely the kill-you-in-three-days problems must be very painful? And if they aren’t very painful, I wouldn’t be going to the ER anyways, so I’d die before my scheduled visit — surely at least a week out in most places I’ve visited
You can become delirious by which point the confusion may make it rather difficult to get treatment. I had a delirious fever from the 2009 swine flu, the fever lasted 3 days and the delirious stage only about 3 hours. It was pretty rapid onset and I couldn’t stand up let alone walk so by the time I noticed it I was unable to seek help. I figured the die had been cast and I’ll see how it turns out. Clearly it turned out ok but there is an inherent selection criteria bias in my post.
My hypothesis for COVID, that I don’t have good data for, was that it has an unusual immune system reaction profile with the long fuse being an under reaction followed by an overreaction and this overreaction could result in particularly damaging spiking high fevers. As someone with a preexisting auto immune condition the overreaction in particular worried me. I was worried that the use of fever suppressants early on in that process might exasperate the effect. I planned ahead of time to ride out the fever and was doing research into changes in mortality rates for Covid based on fever suppressants and I couldn’t find good data and was surprised by the lack of research to what seemed to me to be an obvious and extremely important question. Not having a good answer, especially for the Covid specific case, I decided to risk it.
When I did get Covid, post vaccine, it was a very rapid onset with a spiking fever of 106f (41c) which I knew was dangerous but again by the time that happened I couldn’t seek help. Thankfully that only lasted for about an hour and by the end of the day the Covid was basically gone.
I think in general I will try to ride out flus without fever suppressants and my N of 1 experiment seems to suggest that works. But agains selection criteria bias on that one. I really wish proper research gets done on this but I guess there isn’t much money in it.
Best I have would be an allergic reaction (possibly with constant exposure where you just keep consuming the allergen). Suffering with increasingly restricted airways and not taking an antihistamine or epipen.
Like I would expect microbes specialized to the human/mammalian system environment to be able to deal with the relatively small temperature range of fevers.
The selection pressure of fever is pretty well-suited to microbial evolution. It's very incremental, and microbes are known to live in a wide variety of temperatures. It seems much easier to get around than antibiotics, for example, which has of course happened.
However, there may have been a time when fever didn't yet exist and therefore the microbes were not yet able to handle it. As the feature evolved in mammals it was successful for a while since it dynamically changed the microbe's environment.
If this arms race process was slow enough the feature may be pretty deeply baked into the mammalian genome and persist today despite a relative lack of usefulness compared to the past and even some increased rate of death in the case of high fever.
I like this idea. This also seems easy to approximate in vitro. Pathogen growth rate at body temp vs pathogen growth rate at fever temp. Are they markedly different?
When I have had a fever, it is not a significant absolute temperature change. Seems reasonable that the infection can handle it. It probably always needs to survive room temperate->human temps, so has mechanisms to cover a large gradient.
Also worth considering natural selection only cares about your genes being passed on, not about your survival. A fever response might be a good way to clear an infection when you're 20 and have yet to pass on your genes, but bad after 50 when evolution expects your grandkids to be able to take care of themselves.
It's even possible that an excessive fever that kills you fast and takes the deadly disease along with it, rather than forcing your kin to spend resources caring for you and potentially catching the disease themselves, is evolutionarily beneficial.
Ha, that’s interesting. We could look at whether more solitary mammals have less of a fever response. The feature isn’t guaranteed to fall off, of course, but if it did that would be good evidence for this theory.
EDIT On the former though I think we’d expect babies to be able to tolerate fever well and they really don’t.
Babies are deliberately fragile - if there is an issue evolution wants to nip it in the bud early rather than wasting years of resources raising someone who is ultimately not going to reach adulthood anyways. This is part of the reason that mortality in the first year is over 14 times higher than in the second year, even in the developed world with modern medical practices.
Evolution doesn't care about babies, they are easily replaceable. Evolution doesn't care about the elderly, they have served their purpose. The most important thing is to keep people in their late teens to early thirties alive at all costs as these are the ones statistically most likely to successfully produce and raise offspring. It is no coincidence that this is also the age where people reach peak physical condition. Nature is brutal, but efficient.
A fever "appears to diminish viral replication". Viruses are the pathogens we mostly deal with. So I tend to avoid NSAIDS for the most part. One other point, sometimes you have a mild elevated temperature that is not considered a fever and don't realize it. 98.6 F/37 C is outdated and is usually higher than normal for most people. If I have a 98.6 reading, I am probably sick. Sub 98.0 is more normal for me, depending on time of day.
I couldn't read the article since it's asking me to sign up. But the recommendation from our pediatrician is to only give our kid antipyretics once the temperature goes above 38 Celsius (under arm reading).
I take a long hot shower if I catch a cold virus - theory being to replicate the effects of elevated body temperature to kill virus, like a fever. It seems to be effective.
I also take a combination of Ibuprofen and Paracetamol (Acetaminophen), but only if I am in quite a lot of discomfort.
I find that in the winter it's important to eat warming food like soups, stews, broths. If I eat a cold sandwich or salad for lunch in the winter then I will often start to feel sick in the afternoon like I'm going down with a cold - a healthy evening hot meal will then restore my health.
If you have mild fever symptoms and you are able to take the time to rest and recover no. But if your fever has lasted for a prolonged period of time and you are unable to take the time to rest, then you may consider taking them.
There is a similar argument for inflammation, if you have a sporting injury or you have worked out and your muscles are sore, should you be taking anti-inflammation drugs or using massage guns which reduce inflammation, when inflammation is your bodies response to rebuild itself. By taking them you are reducing your bodies ability to repair itself, however you may experience less pain and discomfort as a result.
42 comments
[ 202 ms ] story [ 2126 ms ] threadBecause for me, significant fever is always accompanied by some degree of malaise. Without drugs, the only way to relieve it is to conserve energy and immobilize.
My thought is that if you take the pain reliever so that you feel better and are able to do another task then this will likely increase the time needed to recover, since the body is not able to focus as much of it's resources on the immune system while you are doing something else.
If you take a pain reliever and it allows you to rest more effectively than you would be able to without it, maybe that would actually benefit the immune system though.
I’m going to bet the resting is more important than the not resting with a fever. But I’d love to know the scientific answer too.
When illnesses get really bad for me it’s usually because they’ve only let me sleep like five total hours in three nights or something like that, due to fever chills or lots of snot and a very-sore throat. The lack of sleep is what wrecks me.
> The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen.
"Mild fever helps clear infections faster, new study suggests
Research on fish shows waiting before reaching for medications may be beneficial for humans"
So basically nobody has a clue, but we are working on it.
Not everything, just enough that this is bad advice without serious qualification.
I feel like this covers that problem, no? Surely the kill-you-in-three-days problems must be very painful? And if they aren’t very painful, I wouldn’t be going to the ER anyways, so I’d die before my scheduled visit — surely at least a week out in most places I’ve visited
My hypothesis for COVID, that I don’t have good data for, was that it has an unusual immune system reaction profile with the long fuse being an under reaction followed by an overreaction and this overreaction could result in particularly damaging spiking high fevers. As someone with a preexisting auto immune condition the overreaction in particular worried me. I was worried that the use of fever suppressants early on in that process might exasperate the effect. I planned ahead of time to ride out the fever and was doing research into changes in mortality rates for Covid based on fever suppressants and I couldn’t find good data and was surprised by the lack of research to what seemed to me to be an obvious and extremely important question. Not having a good answer, especially for the Covid specific case, I decided to risk it.
When I did get Covid, post vaccine, it was a very rapid onset with a spiking fever of 106f (41c) which I knew was dangerous but again by the time that happened I couldn’t seek help. Thankfully that only lasted for about an hour and by the end of the day the Covid was basically gone.
I think in general I will try to ride out flus without fever suppressants and my N of 1 experiment seems to suggest that works. But agains selection criteria bias on that one. I really wish proper research gets done on this but I guess there isn’t much money in it.
Possibly a very high fever or some sort of dehydrating bowel disease?
I guess you could call applying pressure to and binding a wound OTC, and you could possibly die if you simply choose not to do that?
Like I would expect microbes specialized to the human/mammalian system environment to be able to deal with the relatively small temperature range of fevers.
The selection pressure of fever is pretty well-suited to microbial evolution. It's very incremental, and microbes are known to live in a wide variety of temperatures. It seems much easier to get around than antibiotics, for example, which has of course happened.
However, there may have been a time when fever didn't yet exist and therefore the microbes were not yet able to handle it. As the feature evolved in mammals it was successful for a while since it dynamically changed the microbe's environment.
If this arms race process was slow enough the feature may be pretty deeply baked into the mammalian genome and persist today despite a relative lack of usefulness compared to the past and even some increased rate of death in the case of high fever.
When I have had a fever, it is not a significant absolute temperature change. Seems reasonable that the infection can handle it. It probably always needs to survive room temperate->human temps, so has mechanisms to cover a large gradient.
It's even possible that an excessive fever that kills you fast and takes the deadly disease along with it, rather than forcing your kin to spend resources caring for you and potentially catching the disease themselves, is evolutionarily beneficial.
EDIT On the former though I think we’d expect babies to be able to tolerate fever well and they really don’t.
Evolution doesn't care about babies, they are easily replaceable. Evolution doesn't care about the elderly, they have served their purpose. The most important thing is to keep people in their late teens to early thirties alive at all costs as these are the ones statistically most likely to successfully produce and raise offspring. It is no coincidence that this is also the age where people reach peak physical condition. Nature is brutal, but efficient.
Lots of mammals stand up and start doing things literal moments after they are birthed.
What’s also interesting is that we still have no idea about the mechanism by which acetominophen/paracetamol actually works despite studying it for 150y. https://medicine.tufts.edu/news-events/news/how-does-acetami...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812885/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765667/
I also take a combination of Ibuprofen and Paracetamol (Acetaminophen), but only if I am in quite a lot of discomfort.
I find that in the winter it's important to eat warming food like soups, stews, broths. If I eat a cold sandwich or salad for lunch in the winter then I will often start to feel sick in the afternoon like I'm going down with a cold - a healthy evening hot meal will then restore my health.
There is a similar argument for inflammation, if you have a sporting injury or you have worked out and your muscles are sore, should you be taking anti-inflammation drugs or using massage guns which reduce inflammation, when inflammation is your bodies response to rebuild itself. By taking them you are reducing your bodies ability to repair itself, however you may experience less pain and discomfort as a result.