Catering to our aches and pains: What painkiller is best, and when?

Whether you have a headache, fever, backache, arthritis or other pains and discomfort, over-the-counter pain relievers are our most commonly self- and physician-prescribed medicines of choice in America. There are dozens of pain-relief products. Most contain aspirin, ibuprofen, or acetaminophen. These three drugs, as well as naproxen, relieve pain and reduce fever. Aspirin, ibuprofen, and naproxen also relieve inflammation. They belong to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs).  Here’s a brief guide to which non-prescription, over-the-counter pain relievers to use, and cautions to observe when using them.

Choosing the most appropriate non-prescription pain reliever

Aspirin is widely used for relieving pain and reducing fever in adults. It also relieves minor itching and reduces swelling and inflammation. Aspirin comes as adult-strength (325 mg) or low-dose (81 mg). In addition to relieving pain and inflammation, aspirin is effective against many other ailments. For example, aspirin in low regular low doses may help prevent heart attacks and strokes in certain people. Because of the danger of side effects and the interactions aspirin may have with other medicines, do not try these uses of aspirin without a doctor’s supervision.

Although it seems familiar and safe, aspirin is a very powerful drug. Here are important precautions for aspirin use:

  • Keep all aspirin out of children’s reach. Aspirin increases the risk of Reye syndrome in children. Do not give aspirin to anyone younger than 20 unless your doctor tells you to do so.
  • Aspirin can irritate the stomach lining, causing bleeding or ulcers. If aspirin upsets your stomach, try a coated brand, such as Ecotrin. Talk with your doctor or pharmacist to find out what may work best for you.
  • Because aspirin can increase the risk of bleeding, it is not recommended for new injuries. Take other medicines such as ibuprofen or naproxen for the first two or three days after an injury. If you take a blood thinner (anticoagulant), such as warfarin, or if you have gout, talk to your doctor before you take aspirin.
  • High doses may result in aspirin poisoning (salicylism). To help prevent taking a high dose, follow what the label says or what your doctor told you. Stop taking aspirin and call a doctor if you experience ringing in the ears, nausea, dizziness, or rapid deep breathing.

Ibuprofen (the active ingredient in products such as Advil and Motrin) and naproxen (in products such as Aleve) are other NSAIDs. Like aspirin, these drugs relieve pain and reduce fever and inflammation. Also like aspirin, they can cause nausea, stomach irritation, and heartburn.

Ibuprofen is used to relieve pain from various conditions such as headache, dental pain, menstrual cramps, muscle aches, or arthritis. It is also used to reduce fever and to relieve minor aches and pain due to the common cold or flu. Ibuprofen works by blocking your body’s production of certain natural substances that cause inflammation. This helps to decrease swelling, pain, or fever.

NSAID precautions

Do not use an NSAID for longer than 10 days without talking to your doctor, and talk to your doctor before taking NSAIDs if you have

  • Ulcers or a history of bleeding in your stomach, or stomach pain, upset stomach, or heartburn that lasts or comes back
  • Anemia, bleeding or easy bruising
  • A habit of drinking more than three alcoholic drinks a day — this increases your risk of stomach bleeding
  • High blood pressure, kidney, liver, or heart disease.

Also talk with your doctor before taking NSAIDs if you use blood thinners, such as warfarin, heparin or aspirin, if you take medicine to treat mental health problems, to decrease swelling (water pills), or if you take medicine for arthritis or diabetes.

Acetaminophen (the active ingredient in products such as Tylenol) is an analgesic that reduces fever and relieves pain. It does not have the anti-inflammatory effect of NSAIDS, such as aspirin and ibuprofen, but it also does not cause stomach upset and other side effects. Acetaminophen is typically used for mild to moderate pain. Do not take acetaminophen if you have kidney or liver disease, or drink alcohol heavily (three or more drinks a day for men and two or more drinks a day for women).

Finally, note that when you buy pain relievers, keep in mind that generic products are chemically equivalent to more expensive brand-name products, and they usually work equally well. And if you are pregnant, always check with your doctor or pharmacist before taking a pain reliever.

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