Picking a Pain Reliever: Which One Should You Take?

Picking a Pain Reliever: Which One Should You Take?
by Laurie LaRusso, MS, ELS

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. 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.

Like aspirin, the other NSAIDs may upset your stomach, but they are gentler on the stomach than aspirin. When taken long term in high doses, they 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, 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/
Sources:
American Academy of Family Physicians
American Council on Science and Health
US Food and Drug Administration