The two main OTC pain relievers
If you browse pain relievers online, or walk down the pain relief aisle at the drug store, you see dozens of different boxes and bottles.
Their labels may promise to treat specific pains, such as headaches, back pain, migraines, menstrual cramps, arthritis or muscle aches.
But there are really only two types of pain relievers found over the counter: NSAIDs and acetaminophen.
Save money by ignoring the marketing pitch on the front of the label and reading the ingredients on the back.
Buy the product that has the ingredient you need at price you want.
NSAIDS: Aspirin, ibuprofen and naproxen
NSAID stands for nonsteroidal anti-inflammatory drug. (Steroids are great for reducing inflammation, but are pretty powerful drugs and aren’t available over the counter).
All the NSAIDs work by blocking the production of a certain type of chemical called prostaglandins. Prostaglandins contribute to pain, fever and inflammation.
NSAIDs, therefore, are a good choice to treat:
- inflammation caused by sprains, strains, sore throats, sinus congestion, ear aches, tooth aches, menstrual cramps, or arthritis
- pain associated with injury and inflammation
*Warning! Never give aspirin or non-aspirin salicylates to children or teenagers to treat fevers associated with a suspected virus, such as chickenpox or flu. A serious liver condition called Reye’s Syndrome may result. Ibuprofen, naproxen or acetaminophen are okay.
The most common side effect of NSAIDs is stomach upset. Turns out prostaglandins are also responsible for protecting the stomach! Some people are more sensitive than others. Take the tablets with food and a full glass of water.
NSAIDs are also blood thinners, so you may bleed or bruise more easily. Don’t take with a prescription blood thinner—talk to your doctor first.
Some people prefer naproxen because it is longer lasting. The typical dose is 2 tablets every 8-12 hours rather than every 4-6 hours.
- coated tablets that are less irritating to the stomach
- caplets that are easier to swallow
- liquid gels that are absorbed more quickly
An NSAID is a must for the home medicine cabinet, but you don’t need more than one. I prefer plain ibuprofen tablets and buy the cheapest generic.
With any over-the-counter drug, read the directions and follow the dosing guidelines!
Acetaminophen is a good choice to treat:
- pain, but not inflammation
- stuffy nose (it’s a mild decongestant)
How does it work? Actually, scientists don’t really know! It may simply increase our pain threshold so we don’t notice the pain as much. But that doesn’t explain how it treats a fever…🤔
Acetaminophen is also a good choice if NSAIDs hurt your stomach too much.
HOWEVER, the safety margin of acetaminophen is pretty low. It’s surprisingly easy to overdose and hurt your liver.
The Food and Drug Administration (FDA) recently lowered the safe daily dosing from 4,000 mg per day to 3,000 mg per day. That’s only 6 extra-strength tablets. And acetaminophen is in combination with so many other drugs—decongestants, antihistamines, cough suppressants, etc.
That’s why it’s soooo important to read labels and know what and how much you’re taking!
I use acetaminophen for my garden-variety headaches, and I prefer the regular-strength caplets (325 mg). Generic, of course.
I rarely buy combination products. They are usually more expensive, and I only need one of the ingredients, anyway.
Common combo products are:
- Sleep or “PM” formulations: These typically have ibuprofen or acetaminophen with an antihistamine that makes you drowsy. I suppose these work, but I don’t like the fuzzy-headed feeling that comes in the morning.
- Migraine formulations: Excedrin is one of the most popular OTC migraine drugs. It’s simply acetaminophen combined with aspirin and caffeine.
- Menstrual pain formulations: Midol and Pamprin combine acetaminophen with a diuretic (for bloating) and an antihistamine (why??). I really don’t understand these products because plain ibuprofen is waaay better at treating menstrual cramps.
- Cough, cold and flu formulations: I have previously posted about all of these products.
Bottom line on combo products: Just buy the single ingredients you need. If you really need a pain reliever with a decongestant, you can combine them yourself. It’s cheaper that way and you won’t be taking drugs you don’t need.
Out of all the over-the-counter pain relievers on the market, I have two: ibuprofen and regular-strength acetaminophen. These cover pretty much all my family’s pain-relieving needs.
Topical analgesics are another topic and I’ll cover them in another post!