Choosing a pain reliever can almost be enough to give you a headache. But making the best choice doesn’t have to be complicated.
According to Oklahoma Medical Research Foundation physician-researcher Eliza Chakravarty, M.D., not all over-the-counter pain relievers are interchangeable. “It starts with knowing what each one works best for,” she said.
The three most popular over-the-counter types of painkillers are: acetaminophen (Tylenol), naproxen (Aleve) and ibuprofen (Advil, Motrin). Aspirin was once the most common pain reliever, but it has been largely supplanted by naproxen and ibuprofen, which target similar issues with fewer side effects.
If you have a headache, fever or minor pain, Chakravarty says that acetaminophen is likely the place to start. “It’s purely a pain reliever and fever reducer,” she said.
“It’s also good for people with stomach problems, kidney disease or other chronic health problems, because it has a lower risk of side effects,” she said. “But it doesn’t help relieve inflammation, and that’s its major drawback.” High doses or long-term use of acetaminophen also can cause liver damage, so that can be an issue for those who have liver problems or drink alcohol regularly.
Ibuprofen and naproxen fall into a broad category called nonsteroidal anti-inflammatory drugs or NSAIDs, a category that also includes aspirin. These drugs are also effective fever reducers and pain relievers and, unlike acetaminophen, can also relieve inflammation. Aspirin is still taken in low doses to reduce the risks of heart attack and stroke or act as a blood thinner. Chakravarty said, in general, she does not recommend taking higher doses of aspirin for pain, siding with ibuprofen and naproxen instead.
NSAIDs work by inhibiting the production of chemicals released in the body by injured cells, which trigger pain and inflammation. They are more common for short-term usage in dealing with menstrual cramps, dental pain, muscle aches, arthritis and minor injuries. While acetaminophen can be taken alone, all NSAIDs need to be taken with food.
“NSAIDs actually have more helpful properties than acetaminophen alone,” said OMRF’s Chakravarty. “The problem with NSAIDs is they can make existing kidney problems worse, and they can cause stomach ulcers, even in doses you take over the counter. So if you need to take aspirin, ibuprofen or naproxen for more than three or four days, talk to a doctor to make sure that you don’t need another medicine to protect yourself from complications or side effects.”
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While all of these pain-control medications are largely regarded as safe, as with any drug, they can be dangerous if misused or overused. That’s why Chakravarty urges everyone to take time to learn the pluses and minuses of these drugs—and any drugs you take. Some products may contain more than one pain reliever, so she recommends checking ingredients before taking a new pain reliever.
“The best thing you can do is educate yourself about these products,” said Chakravarty. “If you have questions about which is best for you or need to use them for more than a few days, always check with your physician.”
