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Picking a Pain Reliever: Which One Should You Take?
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Picking a Pain Reliever: Which One Should You Take?

pain pills All pain relievers are not equal.

It sounds like the opening line of a commercial for a particular brand of pain reliever, but it’s true. Among nonprescription pain relievers, some are best for relieving menstrual cramps, while others do a better job with sprains and strains, and still others reduce fevers.

Your local drugstore probably has an entire aisle (or at least half of one) devoted to nonprescription pain relievers, such as aspirin, Tylenol (acetaminophen), Advil (ibuprofen), and so on. But which one should you take to stop that headache? Or relieve the pain of a sprained ankle? And which one is safe to give to your children? Or your elderly mother?

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, aches and fever due to colds, 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 don't 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.

Aspirin is not recommended for children and teens with a current or recent viral infection because it can cause Reye’s syndrome, a rare disorder that may cause seizures, brain damage, and death. Check with your doctor before giving a child or teen aspirin. In addition, people with the following conditions should not take aspirin: asthma, nasal polyps, bleeding disorders (or those taking blood-thinning drugs), high blood pressure, kidney disease, and the third trimester of pregnancy.

Nonsteroidal Anti-Inflammatory Drugs (Other Than Aspirin)

Besides aspirin, other nonprescription NSAIDs include ibuprofen (Advil, Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). These drugs are more potent pain relievers than aspirin, especially for menstrual cramps, toothaches, minor arthritis, and injuries accompanied by inflammation, such as tendinitis and sprains. They are also effective at reducing fever and inflammation.

Among the NSAIDs, however, there are some important differences. Ibuprofen is the fastest-acting NSAID, and it is approved for use in children. Naproxen sodium provides the longest-lasting pain relief.

When taken long term in high doses, these pain relievers may cause more serious stomach problems, such as bleeding and ulcers in your stomach and intestines. Ketoprofen carries the highest risk of this complication. People with ulcers, asthma, or bleeding disorders (or those taking blood-thinning drugs) should not take NSAIDs. Drinking alcohol while taking NSAIDs increases your risk of bleeding and ulcers in your stomach and intestines. People with kidney or liver problems, high blood pressure, or congestive heart failure should only take NSAIDs after consulting their healthcare provider.

NSAIDs are of particular concern for elderly people because of the risk of bleeding and ulcers in the stomach and intestines. Older adults who need to take NSAIDs regularly are often given prescription NSAIDs that are designed to be gentler on the stomach.

Acetaminophen (Tylenol)

Acetaminophen relieves minor aches and pains, toothache, muscular aches, minor arthritis pain, headaches, and fever. However, acetaminophen does not reduce inflammation, which makes it less effective than NSAIDs at relieving the pain of sprains, muscles strains, and tendinitis.

Acetaminophen has virtually no side effects. However, it can cause serious complications (liver damage) when overdosed. The safe limit of Tylenol intake is currently determined to be 4 g of acetaminophen within 24 hours period, which is eight extra-strength Tylenol tablets (500 mg each). It is important to remember that several prescription type pain killers (eg, 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 breast-feeding women. It does not cause stomach upset or increase the risk of Reye’s syndrome.

RESOURCES:

US Food and Drug Administration
http://www.fda.gov/

References

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .

American Council on Science and Health website. Available at: http://www.acsh.org/ .

US Food and Drug Administration website. Available at: www.fda.gov.

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.



Last reviewed February 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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