Question: What over-the-counter pain medicine is best, and how much can I safely take?
Determining the specific source of pain is important for recommending an appropriate remedy or treatment, as pain is nature’s way of letting you know that something is wrong. For example, the abdominal pain caused by appendicitis requires a different approach than a painful kidney stone, or abdominal muscle strain. A migraine headache is treated differently than a tension headache, and the chest pain from a heart attack is an emergency whereas heartburn is often relieved with antacids. If you are experiencing pain that is new and different for you without an obvious source (like a sprained ankle or sore throat) you should seek medical attention.
Some substances are analgesic, which means they relieve pain directly at the source or decrease the nervous system’s perception of pain. An anti-inflammatory agent blocks the formation of various substances that cause inflammation, which indirectly causes pain often due to an injury or infection.
Acetaminophen or paracetamol (Tylenol) is a mild analgesic that relieves headaches, muscle aches due to injuries and post-surgical pain. It also reduces fever, which may cause pain. It takes effect in about 15-30 minutes and lasts four to six hours.
Ibuprofen (Advil or Motrin) and naproxen (Aleve) are classified as non-steroidal anti-inflammatory drugs (NSAIDs). These are in contrast to steroids, which also relieve inflammation (think cortisone) but require a prescription and have considerably more side effects. Various inflammatory substances are released by the body to fight infection and repair injured tissues. While inflammation can be helpful, it also causes pain. NSAIDs are useful in relieving painful conditions that are caused by inflammation, such sore throats, earaches or skin wounds. Injuries such as strains and sprains or lacerations and abrasions may also result in inflammatory pain that may benefit from NSAIDs. The onset of effectiveness is 20-30 minutes. Ibuprofen lasts about four to six hours and naproxen about 10-12. Don't mix these two drugs.
Aspirin is both analgesic and anti-inflammatory — and it relieves fever. It is a “desert island drug” and is useful for fevers, headaches and muscle or joint pain.
While generally safe at recommended doses, most medications have a maximally effective range. Taking more tablets or capsules at one time, or more frequently than recommended, is of no greater benefit in reducing pain, and may be harmful. Many cold, flu and allergy preparations also have a pain reliever as a component, so make sure you read the labels and don’t accidentally double-up. Acetaminophen is metabolized by the liver and can cause liver failure in cases of overdose. NSAIDs and aspirin can irritate the lining of the stomach and cause ulcers and gastrointestinal bleeding. If you have a sensitive stomach you may consider taking an NSAID or aspirin with some food. Alcohol increases overall bodily inflammation so it may make pain worse, and at the same time it dulls your senses, so it should be avoided if you take any OTC pill.
Taking any of these OTC medicines for short periods of time (7-10 days) are safe, but prolonged or chronic pain should always be investigated by a doctor. As with all medications, if you are allergic, are taking other prescription drugs or have a medical condition that may be affected by over-the-counter medicines, make sure you talk to a doctor if you are unsure about the safety of any of these substances.