Know Your Pain Reliever Options & How to Choose Between Them

When you have a nagging pain that won’t go away, over-the-counter (OTC) pain relievers can offer quick relief. After rifling through your medicine cabinet, there may be several options to choose from. Ibuprofen, acetaminophen, aspirin and more – what’s the difference? Although many OTC pain products can address similar concerns, they aren’t all the same.

Yasmin Nejad, PharmD, from Samaritan Pharmacy – Corvallis, outlined the differences between four common pain relievers, and when you might use one or the other.

Acetaminophen

Acetaminophen, found in Tylenol and other OTC medications, is believed to work by blocking pathways in the brain so you don’t feel as much pain and may also inhibit pain systems in other parts of the body. Acetaminophen is effective at addressing a broad range of aches and pains as well as reducing fever. It has a minimal side effect profile when taken correctly and safely, which makes it a great place to start if you are having mild pain like a headache.

“Acetaminophen can be a good starting point for individuals in mild to moderate pain,” said Nejad.

This drug is metabolized by your liver, so don’t take it with alcohol or if you have liver problems. It can also be dangerous to take with a common blood thinning medication called warfarin and may cause an increased risk of bleeding at high doses for a long period of time.

Ibuprofen

Ibuprofen can be found under the brand names Motrin or Advil. It is a type of pain reliever called a nonsteroidal anti-inflammatory drug (NSAID), which works by inhibiting processes in the body that can cause pain and inflammation responses, resulting in pain relief. This makes it helpful for conditions like an earache or a twisted ankle, where swelling contributes to discomfort, however it should not be taken for treating inflammation unless at the direction of a health care provider. Ibuprofen can also be used to help reduce fever.

This drug is metabolized by the liver and affects the kidneys, so people with liver problems should exercise caution. People who don’t have full kidney function or take other medications that affect kidneys may not be able to take ibuprofen. Ibuprofen can also increase your bleeding risk, which can be a problem for people with clotting disorders or who are already on a blood thinning medication like warfarin. Ibuprofen can also worsen certain heart conditions and increase blood pressure.

Side effects from ibuprofen can include nausea, heart burn or gastrointestinal upset like diarrhea or constipation. Nejad recommended taking the medication with food if you notice any of these uncomfortable side effects.

“There are some cases where the effects of an NSAID are helpful so if acetaminophen isn’t easing your pain, ibuprofen could be the next step if you are able to take it,” said Nejad.

Aspirin

Aspirin is widely available, but Bayer is one of the more common brands. It is another form of NSAID and works in the body in a similar fashion to ibuprofen to control pain.

While all NSAIDs have some level of blood-thinning ability, aspirin is especially good at it. In fact, aspirin is most commonly used in low doses as a daily defense against heart attack or stroke. Nejad reported that while aspirin can help with minor pain, headache or fever, ibuprofen is usually preferred because it is considered better tolerated and better at reducing pain.

Naproxen

Naproxen, found in Aleve, is another type of NSAID. It can help with pain from sources such as arthritis, menstrual pain or a headache. Nejad noted that naproxen has a similar side effect profile to ibuprofen and can be considered if ibuprofen is not effective. It also has a longer duration of pain relief compared to ibuprofen.

Watch Out for Added Acetaminophen

When you don’t feel well, check the label on cough and cold medications, sleep aids or combination pain medications. Acetaminophen is often added to these items so if you’re taking multiple medications containing acetaminophen, you could be getting too much.

“Acetaminophen is generally well tolerated at regular doses, but the window of safety becomes smaller as the amount taken increases,” Nejad said. “At toxic levels, acetaminophen can do a lot of damage, so it’s very important to pay attention to how much you are taking a day.”

The current maximum dose of acetaminophen is 3,250 mg in a 24-hour period for most people with healthy liver, however some experts recommend only going up to 3,000 mg per 24 hours.

Managing Pain & Long-term Use

OTC pain relievers can be helpful for occasional pain, but don’t depend on them for long-term relief without consulting your primary care provider first.

“NSAIDs like ibuprofen and naproxen can be irritating to the lining of the stomach and small intestine, and can cause small sores called peptic ulcers,” said Nejad. “If you have persistent pain, such as daily arthritis pain or an old injury, using NSAIDs long term may not be safe unless you are under a doctor’s guidance.”

Taking ibuprofen for a short time, like for an arthritis flare up or headache, isn’t usually a problem, she noted.

Although acetaminophen is potentially better tolerated than NSAIDs, taking it frequently in high doses can also be harmful and may lead to liver damage.

If you are still having pain while taking the maximum daily dose of acetaminophen or ibuprofen, it is usually safe to alternate between the two for a day or two, said Nejad.

“Take a regular dose of acetaminophen and then four hours later a regular dose of ibuprofen,” she said. “Since they work differently in the body those two drugs can work together to safely manage your pain for a short time.”

Just make sure you aren’t exceeding the daily maximum of either medication and be sure to note whether your pain is getting better.

“If you are reaching for an OTC pain reliver most days for 10 days or longer, please consult with your primary care provider to discuss the cause of the pain and long-term treatment goals,” said Nejad. “There are also many OTC products available that can be applied to the skin for local pain relief. Non-opioid options are also available with a prescription from your provider that can be used if indicated.”

	Acetaminophen	Ibuprofen	Aspirin	Naproxen
Common Products	Tylenol.	Motrin & Advil.	Bayer.	Alleve.
Common Uses	Arthritis. Fever reducer. Headache. Minor aches & pains. Cold & flu symptoms.	Arthritis. Fever reducer. Headache. Muscle pain & strains. Menstrual cramps. Earache. Toothache.	In low doses to prevent heart attack or stroke as recommended by a health care provider.  Minor aches and pains	Arthritis. Fever reducer. Headache. Muscle pain & strains. Menstrual cramps.
Maximum Daily Dose	3,250 mg/24 hours.	1,200 mg/24 hours.	3,900 mg/24 hours.	600 mg/24 hours.
Don’t Use or Confer With a Health Care Provider If Any of the Following Apply	Liver disorder. Take warfarin.	Kidney disorder. Allergy to aspirin. Take blood thinning medication. Clotting disorder. Heart disease. High blood pressure. Stomach ulcers or bleeding. Pregnancy.	Kidney disorder. Take blood thinning medication. Clotting disorder. High blood pressure. Stomach ulcers or bleeding. Pregnancy. 18 years old or younger.	Kidney disorder. Take blood thinning medication or daily aspirin. Clotting disorder. Heart disease. High blood pressure. Stomach ulcers or bleeding. Pregnancy. 12 years old or younger.

Fever & Pain Relief for Kids

Talk to your child’s pediatrician before giving pain relievers to children younger than 6 months old. For children older than 6 months, always use a pain reliever that is formulated for children and select the correct dose based on their weight, not age. Both acetaminophen and ibuprofen are effective at helping to lower fever, but a report printed by the American Academy of Pediatrics suggested ibuprofen is often preferred because it may be able to lower the fever for longer.

Never give aspirin to children or teens younger than 18, because of the risk of a rare side effect called Reyes syndrome that can affect the brain and liver. Naproxen should not be given to children under age 12.

How to Pick the Right Pain Reliever

Nejad recommended always starting with the lowest dose that gives you the relief you need, no matter which product you choose.

“For most people, acetaminophen has fewer side effects and is a good place to start for general pain relief. However, there are some cases where ibuprofen is more effective,” said Nejad. “Those are usually my first two recommendations because they do a good job of managing mild to moderate pain and are easily available.”