Pain Relievers




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Non-Prescription Pain Relievers


From time to time we all experience persisting pain—headaches, sinus problems, or muscle and joint pains, for example. Commonly we go to a pharmacy or supermarket in search of non-prescription remedies. There we find a large number of pain medications, but little advice on how to choose between them.

Medications that relieve pain are called "analgesics." Most non-prescription pain medications can be classified as simple analgesics or anti-inflammatory analgesics.  

Simple analgesics include acetaminophen (Tylenol(R) and others). These are often effective in relieving occasional, mild-to-moderate aches and pains and cause very little stomach irritation. They also help reduce fevers. However, drugs like acetaminophen do little to relieve inflammation, which is a significant factor in many kinds of pain.

Anti-inflammatory analgesics include aspirin (Bayer(R), Bufferin(R), and others), as well as a variety of newer "non-steroidal anti-inflammatory drugs" (NSAIDs) such as ibuprofen (Motrin(R), Advil(R), Nuprin(R) and others), naproxen (Alleve(R) and others), and ketoprofen (Orudis (R), Actron(R), and others). Anti-inflammatory analgesics, like the simple analgesics, are effective in relieving many kinds of mild-to-moderate pain and also in relieving fever. They differ such that when they are taken regularly over time, these medications also reduce inflammation (the effect builds up with repeated doses); inflammation may accompany conditions like arthritis and other musculo-skeletal pain. The major disadvantage to aspirin and—to a lesser extent—the newer NSAIDs is that they can cause stomach irritation and sometimes even bleeding ulcers. Aspirin and other NSAIDs also reduce the blood’s clotting ability, making a person somewhat more prone to bleeding from a variety of causes.

Studies indicate that when taken at recommended doses, the amount of pain relief obtained from most of these different analgesics is—on average—about equal, although on an individual basis, people report different responses among the different medications. Side effects can vary among people as well. We suggest the following guidelines for using non-prescription pain medications.

Know why you are having pain. If your pain is unusual, persistent, getting worse, or unexplained, seek advice from a doctor. Make sure any underlying illness or injury gets treatment first.

Remember that non-prescription analgesics are very useful for conditions like headaches, back pain, joint aches, and other musculo-skeletal pain. But they are NOT very effective relieving deep internal pain like stomach aches.

Read the labels and know the ingredients; don’t exceed the recommended dose unless advised so by a physician.

If you take aspirin or an NSAID on an empty stomach, always take it with a full glass of water (or juice or milk). You may have less stomach irritation if you take it with meals, although it may not take effect as quickly.

With aspirin and other NSAIDs, you can expect some pain relief quickly, but the added anti-inflammatory effect may not be fully achieved until you have been on the medication for a few days.

Unless your physician recommends it, avoid anti-inflammatory analgesics (aspirin and the newer NSAIDS) if you have any of these conditions:

stomach ulcers or a history of gastro-intestinal bleeding

surgery (for a week or two before and after)

hemophilia, bleeding tendencies, or anticoagulation (taking "blood thinners")

pregnancy, especially the last trimester

asthma, in some cases

Persons with serious kidney or liver disease should also check with a physician before taking any over-the-counter analgesics

Single over-the-counter pain medications can generally be taken safely with other common medications like antihistimines (allergy relievers), antibiotics, or antidepressants. In most people, these pain relievers do not cause significant drowsiness. But be careful of mixing non-prescription pain relievers with combination medications, especially sinus and cold remedies that may already contain aspirin, acetaminophen, or ibuprofen. Again, read the fine print on the drug labels. One other drug combination is worth mentioning: If you occasionally take an analgesic for headache, then taking caffeine in addition (either in a combination medication or in a cup of coffee) may be more effective in relieving the headache than the analgesic alone.

In some chronic pain conditions, frequent or regular use of higher doses of over-the-counter pain relievers may become less effective. Also, such use—in a small percent of the population—has been linked to increased risk of permanent kidney damage. Consult your doctor if you find you need to use these medications frequently at higher doses or on a daily basis.

While non-prescription pain relievers can manage most kinds of occasional pain, they are not intended for all kinds of pain. If pain is chronic, remember that there are other things you can do to help manage it. You can consult with your doctor about non-drug treatments such as exercise, physical therapy, massage, relaxation techniques, and biofeedback techniques. Some special conditions like migraine headaches may respond well to prescription medications. And for serious chronic pain that complicates illnesses like cancer and AIDS, a variety of prescription medications and expert care are essential to provide effective relief.


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