Over-the-Counter Pain Medications

Making the Right Choice

We don’t need to visit the doctor every time we want a treatment for pain; there’s an abundance of products to choose from in any pharmacy, grocery store, or even gas station! Being available without a prescription does not guarantee a pill is safe, though. In fact, this easy accessibility increases the risk of incorrect usage and using too much. It is very important to understand how to select the best over-the-counter pain medication for your particular situation, and just as important, to know which ones you should avoid.

Aspirin, derived from willow bark, is the original pain medication. Egyptian writings from as far back as 2000 BC describe it’s use for pain and fever control. It is such an effective anti-inflammatory agent that it is the first medication advised by physicians for some medical problems, such as thyroiditis (inflammation of the thyroid), and phlebitis (inflammation of the veins).

But it’s potent adverse effects limit its usefulness in non-doctor directed scenarios. For instance, if children take aspirin during certain types of viral illness, they can develop a potentially fatal condition called Reye’s Syndrome. Also, aspirin is a potent stomach irritant and a common cause of stomach ulcers. And it is a powerful blood thinner. It is used to prevent heart attacks, strokes, and deep vein thrombosis (leg blood clots). However, this effect is so long acting that surgeons will defer an elective procedure for 2 weeks should a patient have any aspirin in their system. 

Acetaminophen, best known as the popular brand Tylenol, is another commonly used and effective medicine for mild-to-moderate pain relief. Unlike aspirin, which can actually reduce the inflammatory response causing the pain, acetaminophen soley works on the uncomfortable symptoms without altering the root cause. The big advantage it has over other pain medications is that it doesn’t bother the stomach. That makes acetaminophen the number one choice for anyone with stomach issues, like ulcers, acid reflux, or even just “a delicate system.” Also, if you need to take something on an empty stomach, this is the best option.

There are two huge downsides to acetaminophen, though. First, it is metabolized through the liver, so anyone with a liver issue should stay away from it. This includes someone looking for a hangover remedy; the stress of alcohol on the liver from the night before dramatically increases the potential for liver toxicity from this medication. Secondly, acetaminophen is a “hidden” ingredient in many other over-the-counter and prescription drugs, so you can exceed the safe dosage of this substance without even knowing it.

Ibuprofen, marketed under the brand names “Advil” and “Motrin,” is another common and effective pain reliever. Like aspirin, it reduces discomfort and any underlying/causative inflammation and so is termed an NSAID (non-steroid anti-inflammatory drug). It’s beneficial effects persist in the body longer than aspirin, and it does not share the risk of Reye’s syndrome, so it is preferred over aspirin in many scenarios. But like aspirin, it can be very irritating to the stomach, and so it should be avoided by anyone with gastritis, ulcers, or acid reflux. Additionally, regular use of ibuprofen can cause kidney damage and blood pressure elevation. This drug should not be taken by anyone with these health conditions without physician direction.

Naproxen, marketed under the brand name “Aleve,” is another NSAID very similar to ibuprofen in its effects and side effects. Its effect in the body lasts even longer than ibuprofen, which may be useful in some situations, but the side effects of upset stomach, kidney irritation, and increased blood pressure limits its safety for long-term use.

Choosing the right pain reliever is even more difficult when you consider that some popular brands have varying or mixed ingredients. Midol, a successful menstrual pain reliever, has one version that contains acetaminophen, another that contains naproxen, and a third that contains ibuprofen! Popular “cold” remedies also have a significant amount of pain relievers in addition to the active ingredients that fight congestions. And Excedrin, a headache medication, typically contains both acetaminophen and aspirin.

Doctors take care selecting the right prescription medicine for their patients. Consumers need to be just as diligent in choosing the right over-the-counter pain medication. Read the ingredients, so you know exactly which chemical you are getting. Anyone with liver problems or recent heavy alcohol use should avoid acetaminophen. Ibuprofen and naproxen, on the other hand, should be avoided by those with stomach, kidney, or blood pressure problems. And aspirin should be reserved for adults. It’s most important role is clot prevention, rather than pain relief. Take great care regarding what you put in your body. It is a magnificent machine!

Patrice Thornton, MD, is a family physician at SVMC Northshire Campus in Manchester Center, VT. The practice is a part of Southwestern Vermont Medical Center. Dr. Thornton is accepting new patients.