Antispasmodics vs. Painkillers: What's the Difference and When to Take Them

 5 mins 30 sec

Topic

  • Managing Abdominal Pain

Whether it’s just causing you discomfort or making you want to curl up in a ball, tummy pain is a nuisance, to say the least. But what’s the best medicine to get rid of it? Antispasmodics or painkillers?

Unlike painkillers, antispasmodics treat the root cause of pain by acting directly where they are needed in the gut. In other words, they work to alleviate the cramps and pain at the source itself. Meanwhile, painkillers simply cut signals to the brain, but do not specifically work on the site of pain and cramping.

Read on to find out how both of these drugs work, what they are used for, and some further key differences between them.

Painkillers: What are They and What Do They Do?

Painkillers (also called pain relievers or analgesics) are medications used to treat and manage pain1. They include:

  • Acetaminophen (also known as paracetamol)
  • nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or aspirin)
  • local anesthetics
  • Opioids
     

Paracetamol or acetaminophen and NSAIDs are non-opioid painkillers medicine available over-the-counter (OTC) or without a prescription, providing effective pain relief. Opioids are prescribed by your doctor. Local anesthetics can be prescription or non-prescription, depending on the specific medication.

Painkillers work by targeting different pathways in the body to reduce pain signals or inflammation. Acetaminophen primarily acts in the brain, altering the perception of pain. NSAIDs reduce inflammation, and opioids, on the other hand, bind to receptors in the brain and spinal cord, modifying how pain is processed and providing relief for moderate to severe pain.

Use Over-the-Counter Painkillers

Paracetamol is used to treat mild and moderate pain, and to reduce fever1.

NSAIDs are used to1:

  • relieve mild or moderate pain
  • reduce fever
  • relieve pain associated with inflammation
  • reduce swelling2
     

Paracetamol or NSAIDs can help treat the following types of acute pain,2, 3, 4 too:

  • headaches and migraines
  • toothache
  • period pains
  • pain from sprains
  • fever from colds and flu
  • general aches and pains
  • pain associated with inflammation, for example, in conditions such as rheumatoid arthritis and osteoarthritis (NSAIDs, in particular, are suited here)

How do OTC Painkillers Work?

NSAIDs relieve pain and have an anti-inflammatory effect. They work by stopping the production of certain chemicals that cause inflammation and pain.

It is unclear exactly how paracetamol relieves chronic pain1. However, researchers traditionally believe that it inhibits specific pathways in the central nervous system, similar to NSAIDs6.

Another key difference between NSAIDs and paracetamol is that the latter does not reduce inflammation6.

Finally, some experts also believe that paracetamol relieves pain by activating the brain’s natural pain-relieving system, called the endocannabinoid system6.

Finally, some experts also believe that paracetamol relieves severe pain by activating the brain’s natural pain-relieving system16.

Side effects of OTC Painkillers

Paracetamol and NSAIDs are generally safe when taken correctly. However, side effects can sometimes occur.

Paracetamol side effects are rare1, 3. They include:

  • rashes, swelling, or allergic reactions
  • blood disorders, such as anemia (low number of red cells), leukopenia or neutropenia (low number of white blood cells)
  • liver damage (4g max daily dose must be respected to avoid this)
  • some metabolic and electrolyte disorders, such as high blood sugar, or low calcium levels
     

NSAIDs such as ibuprofen and aspirin may cause side effects. However, not everyone gets them.

For ibuprofen, typical side effects include4:

  • nausea or vomiting 
  • constipation or diarrhea 
  • indigestion (dyspepsia) or abdominal pain 
     

 For aspirin, typical side effects include2:

  • indigestion and stomach aches 
  • bleeding or bruising more easily 
     

 All NSAIDs may cause: 

  • gastrointestinal side effects, such as nausea, anorexia, indigestion, abdominal pain, ulcers, stomach bleeding, perforation, constipation, and diarrhea 
  • Kidney-related side effects, such as salt and water retention, kidney damage  
  • cardiovascular side effects, including hypertension, bruising and bleeding more easily

Antispasmodics: What are They?

Antispasmodic medicines help stop muscle spasms, contractions, or cramps.

Antispasmodic medicine like hyoscine N-butylbromide (Buscopan®) is commonly used to treat gastrointestinal or bladder spasms. It works by targeting the muscles in the gut wall to reduce contractions without affecting the brain, making it a localized and well-tolerated option.

Antispasmodics: What do they do?

Hyoscine N-butylbromide (Buscopan) and Other Antimuscarinics

Hyoscine N-butylbromide (Buscopan), in particular, decreases the movement of the gut (gastrointestinal motility) and acts on receptors in the stomach’s smooth muscle9. For these reasons, it is used for treating various types of abdominal pain, such as12:

  • gastrointestinal spasms
  • spasm of the genito-urinary tract
     

To find out more about the different types of abdominal pain, read our article, Understanding Abdominal Pain and What it Means for Your Health

Learn more: "What Does the Location of my Abdominal Pain Mean?"

How Do Antispasmodics Work?

Hyoscine N-butylbromide (Buscopan®)

A benefit of Hyoscine N-butylbromide (Buscopan®) is that it acts locally. By acting locally on the gut wall, it relaxes the smooth muscles of the belly, reducing painful contractions.

(Hyoscine N-butylbromide) Buscopan® does not cross the blood-brain barrier, a permeable membrane that can let some molecules pass through the brain. (Hyoscine N-butylbromide) Buscopan® is effective locally and is retained in the tissues of the gastrointestinal and urogenital tracts12. This makes (Hyoscine N-butylbromide) Buscopan® efficient and tough on pain, while remaining gentle on the stomach12. It also means it won’t affect you in other areas of your body, or other ways, such as impairing your driving ability.

Hyoscine N-butylbromide (Buscopan®) is part of a class of antimuscarinics that are generally better tolerated than other antimuscarinics8. This is because they are less likely to cross the blood-brain barrier and are therefore unable to reach the central nervous system8, where they could cause unwanted side-effects.

Most people who take Hyoscine N-butylbromide (Buscopan®) experience no side effects. In very rare instances people may experience minor side effects, such as14:

  • dry mouth
  • constipation
  • blurred vision
  • increased heart rate

Antispasmodics vs. OTC Painkillers

Unlike some painkillers, which cut the pain signals in the brain and do not solve the pain itself, antispasmodics like (Hyoscine N-butylbromide) Buscopan® relieve cramps and abdominal pain at the source. That is to say, OTC painkillers work all over the body, as opposed to focusing on the site and cause of pain, like Buscopan®.

Furthermore, antispasmodics such as (Hyoscine N-butylbromide) Buscopan® are tough on abdominal pain, but at the same time are well tolerated and gentle on the tummy, unlike a painkiller such as ibuprofen.

Antispasmodic medicine generally has a well-established safety profile10. Evidence also suggests that in some forms of abdominal pain, antispasmodics have an edge over analgesics. For example, one study of women living with abdominal pain, cramps, and discomfort found that hyoscine butylbromide was perceived as being more effective than painkillers, and even helped people return to their daily activities more quickly17.

Another study compared hyoscine butylbromide with aspirin to treat period cramps and found that both compounds were effective18. However, the study suggested hyoscine butylbromide may be a safer treatment option, because aspirin may cause gastrointestinal bleeding.

Don’t let belly pain hold you back.

Learn to help your belly

Find your (Hyoscine N-butylbromide) Buscopan®