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Aspirin the ultimate painkiller? You may be using acetylsalicylic acid incorrectly

15.5.2023

Translation: Veronica Bielawski

Aspirin isn’t the best painkiller. But it has other helpful properties: it thins the blood and, taken at the right moment, can even save your life. Here’s what you should know about acetylsalicylic acid (ASA).

You’ve probably taken some aspirin to combat pain more than once in your life – and you’re not alone. After all, the little white pills are probably the best-known painkiller. But there are more suitable treatments for pain. Why? Because aspirin is primarily a blood thinner. It can certainly help against headaches, but may also harm your stomach in the long run.

History crash course: from willow bark to acetylsalicylic acid (ASA)

«Aspirin» is actually a brand name originally registered by Bayer AG in 1899 for acetylsalicylic acid (ASA). The drug was already on the market back then, having begun its triumphal march as a painkiller. The name aspirin is derived from the old name for acetylsalicylic acid (acetylspiric acid), which references willow bark as the original source of the active ingredient.

Willow bark contains salicin, which is converted to salicylic acid in the body. The analgaesic and antifebrile properties of willow bark were known in ancient times. Today, salicylic acid is produced synthetically and then modified to acetylsalicylic acid. This allows for more accurate dosing and better tolerability than the use of willow bark or salicylic acid.

The world’s most well-known painkiller has side effects

The name «Aspirin» is trademarked by Bayer AG to this day. But the patent on acetylsalicylic acid has long been out of force; today, there are a number of ASA-containing generic products under a different name. Even so, Bayer generates annual sales of several hundred million euros with Aspirin in Germany and Switzerland.

The drug is even more popular in the USA, where huge bottles of pills seem to be a bathroom cabinet staple – with people practically popping them for breakfast. This is because ASA isn’t used there so much to treat pain. Instead, it more frequently serves to prevent cardiovascular disease, especially in people with a higher risk of heart attacks or strokes. This use of aspirin is controversial, however; taken frequently, ASA can irritate the gastrointestinal tract and cause abdominal pain, nausea, vomiting and even stomach ulcers.

Alternative painkillers such as paracetamol or ibuprofen are just as good as if not better than aspirin for treating pain – and are often better tolerated and have fewer or different side effects. Of course, you should inform yourself before taking any drugs and never exceed the recommended maximum doses.

When aspirin can save lives

For the reasons mentioned above, the use of ASA on a permanent basis for the prevention of cardiovascular disease is less advisable. As a blood thinner, however, aspirin can save lives in certain situations. In emergency medical care, ASA is often used for the acute treatment of strokes and heart attacks. Medical personnel inject the drug directly into the bloodstream to make it work faster. The blood-thinning effect can help dissolve blood clots and prevent new ones from forming.

But you shouldn’t reach for the tablet yourself in this case. Compared to intravenous administration by a medical professional, swallowing a pill takes much longer to work. In addition, aspirin isn’t recommended for all patients with a stroke or heart attack. Especially in people with a known aspirin allergy, gastrointestinal ulcers, or bleeding disorders, ASA can cause serious health complications, including allergic reactions or internal bleeding.

No ASA before surgery

As helpful as the blood-thinning effect can be in some cases, it can be unfavourable; during surgery, it’s important to keep blood loss to a minimum – and a functioning blood clotting system is essential for this. The German Society of Anaesthesiology and Intensive Care Medicine (DGAI) therefore recommends that patients who regularly take aspirin stop taking it at least seven days before surgery to reduce the risk of bleeding during or after the procedure. The basic principle to keep in mind is that each person reacts individually to medications. Because of this and the possible interactions with medications, you should always consult your doctor.

ASA against cancer: what else can aspirin do?

Various studies have shown that aspirin is able to kill cancer cells and inhibit tumour growth. In 2021, for example, a Chinese research team published a metastudy on the effect of aspirin in the prevention and treatment of cancer. They concluded that
regular use of aspirin may reduce the risk of colon and bile duct cancer and contribute to a higher rate of survival. Aspirin could thus play an important role in the prevention and treatment of cancer.

Header image: Dan Smedley/Unsplash

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Anna Sandner

Senior Editor

Anna.Sandner@galaxus.de

Science editor and biologist. I love animals and am fascinated by plants, their abilities and everything you can do with them. That's why my favourite place is always outside - somewhere in nature, preferably in my wild garden.

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