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Picking a Pain Reliever: Which One Should You Take?

  • pain pills All pain relievers are not equal. Your local drugstore probably has an entire aisle devoted to nonprescription pain relievers, such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and so on. Many medicines can help relieve pain, but different types of pain relievers can have different side effects and potential risks.
  • Aspirin

    Aspirin is actually the first of a type of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). As the name suggests, NSAIDs reduce inflammation in addition to relieving pain. Aspirin is effective at relieving the pain of headaches, toothaches, muscular aches and pains, and minor aches and pains of arthritis.
    The vast majority of people can take aspirin without experiencing any side effects. However, aspirin may upset your stomach. To minimize stomach upset, some aspirin products are buffered with an antacids or coated so the pills do not dissolve until they reach the small intestine. When taken long-term in high doses, aspirin may cause more serious stomach problems, such as bleeding and ulcers in your stomach and intestines. For this reason, people with ulcers should not take aspirin. Additionally, drinking alcohol while taking aspirin increases your risk of bleeding and ulcers in your stomach and intestines.
    Children and teens should not take aspirin if they have a viral infection such as the flu because it can cause Reye’s syndrome in these age groups. Reye's syndrome is a rare disorder that may cause seizures, brain damage, and death.
    In addition, people with the following conditions should not take aspirin:
    • History of asthma , rhinitis, and nasal polyps, known as the aspirin triad
    • Severe liver or kidney disease
    • Bleeding disorder
    • Aspirin or salicylate allergy
    • Pregancy or lactation
  • Nonsteroidal Anti-Inflammatory Drugs Other Than Aspirin

    Besides aspirin, other nonprescription NSAIDs include medicines like ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). These drugs are useful for menstrual cramps, toothaches, minor arthritis, and injuries accompanied by inflammation such as sprains . They are also effective at reducing fever and inflammation.
    Among the NSAIDs, however, there are some important differences. Ibuprofen stays in the system for less time and may need to be taken up to every 4-6 hours.
    Naproxen sodium provides longer lasting pain relief and is usually taken every 12 hours.
    When taken long-term in high doses, these pain relievers may cause serious stomach problems, such as bleeding and ulcers in your stomach and intestines. Drinking alcohol while taking NSAIDs increases your risk of bleeding and ulcers in your stomach and intestines. NSAIDs are of particular concern for elderly people because of the risk of bleeding and ulcers in the stomach and intestines.
    NSAIDs can also increase the risk of heart attacks and strokes, especially with long term use or in people who already have heart disease.
    People with a history of allergic reactions to aspirin or NSAIDs, the apirin triad, and pregnant women in the third trimester should not use NSAIDs. Consult with your doctor before taking NSAIDs if you have:
    • A history of bleeding disorders
    • Take blood-thinning medication
    • Kidney or liver problems
    • High blood pressure
    • Heart failure
  • Acetaminophen

    Acetaminophen (Tylenol) relieves minor aches and pains, toothache, muscular aches, minor arthritis pain, headaches, and fever. However, acetaminophen may not reduce pain as well as NSAIDs if the pain is due to osteoarthritis.
    Acetaminophen has virtually no side effects when taken at recommended doses. However, it can cause serious complications, like liver damage, when taken in excess. It is important to remember that several prescription type pain killers, such as Percocet and Vicodin, contain acetaminophen as one of the ingredients. One needs to be aware of this, as taking these in high number or taking them with Tylenol may easily lead to overdose. Moreover, when taken along with alcohol, acetaminophen increases the risk of liver damage. This includes taking the drug the morning after a night of heavy drinking.
    Acetaminophen is the pain reliever and fever reducer of choice for children and pregnant and breastfeeding women. It does not cause stomach upset or increase the risk of Reye’s syndrome . But, there are some studies that suggest an increase risk of developing asthma for people who take acetaminophen.
  • RESOURCES

    American Academy of Family Physicians http://familydoctor.org

    United States Food and Drug Administration http://www.fda.gov

    CANADIAN RESOURCES

    Canadian Pharmacists Association http://www.pharmacists.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Acetaminophen. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated February 12, 2013. Accessed March 13, 2013

    Aspirin. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated January 18, 2013. Accessed March 13, 2013.

    Aspirin: questions and answers. US Food and Drug Administration website. Available at: http://www.fda.gov/drugs/resourcesforyou/consumers/questionsanswers/ucm071879.htm. Updated July 6, 2006. Accessed March 13, 2013.

    Henderson AJ, Shaheen SO. Acetaminophen and asthma. Paediatr Respir Rev . 2013;14(1):9-15.

    Ibuprofen (NSAID) pain reliever/fever reducer. Daily Med website. Available at: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ee241be0-35f8-4789-a71f-98de31d6a590. Updated December 2012. Accessed March 13, 2013.

    Naproxen sodium (NSAID) pain reliever/fever reducer. Daily Med website. Available at: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ee241be0-35f8-4789-a71f-98de31d6a590. Updated July 2010. Accessed March 13, 2013.

    Rumack BH. Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol . 2002;40:3.

    Lee WM. Acute liver failure in the United States. Semin Liver Dis . 2003;23:217-226.

    Lee WM. Drug-induced hepatotoxicity. N Engl J Med . 1995;333:1118-1127.

    Understanding your OTC options. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/pain-relievers-understanding-your-otc-options.html. Updated February 2012. Accessed March 13, 2013.

    Zhang W, Jones A, Doherty M. Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Ann Rheum Dis . 2004 Aug;63(8):901-7

    8/23/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Beasley R, Clayton T, Crane J, et al. Acetaminophen use and risk of asthma, rhinoconjunctivitis and eczema in adolescents: ISAAC phase three. Am J Respir Crit Care Med. 2010 Aug 13 early online.

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