> Paracetamol has a central analgesic effect that is mediated through activation of descending serotonergic pathways. Debate exists about its primary site of action
https://pubmed.ncbi.nlm.nih.gov/18811827/
We do know how it works, there’s just debate over which receptor site in particular it uses. Paracetamol is an old drug that’s been used for decades, we know all the side effects, we know what groups can take it and what groups can’t. If it were invented today would it pass regulators with this discrepancy? Probably but it would be harder and probably more tightly controlled and not sold in most shops. We still don’t know fully how anaesthetics and hypnotic drugs work. We just know that they do.
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