There are two basic types of over-the-counter pain relievers:
- NSAIDs (nonsteroidal anti-inflammatory drugs). These include aspirin, ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT).
- Acetaminophen (Tylenol and Panadol).
Some products combine these pain relievers with other ingredients like caffeine or decongestants, and market the product for combinations of symptoms. You'll sometimes see these products advertised for cold and flu relief. These added ingredients may address symptoms including nasal congestion or cough.
In general, ibuprofen, naproxen and ketoprophen reduce pain more than the same dose of acetaminophen or aspirin, although acetaminophen and aspirin have other advantages. Acetaminophen is often recommended for treating the pain of arthritis because it doesn't cause stomach irritation. It is also the safest pain reliever for children. And aspirin is the only pain reliever shown to reduce the risk of heart attack.
NSAIDs prevent the body from manufacturing prostaglandins. Prostaglandins are substances produced naturally by the body that act as mediators for a variety of physiologic functions including protecting the stomach lining, and regulating blood pressure. They also mediate pain and inflammation. An NSAID works by blocking all prostaglandins. So while they block those that cause pain, they also block those that protect the stomach lining and can, therefore, cause stomach upset or gastrointestinal bleeding in some people. The risk of problems increases with long-term use of NSAIDs. However, NSAIDs are effective at reducing aches, pain, fever, and inflammation.
Although effective at reducing pain and inflammation, NSAIDs aren't recommended for use before or during endurance sports. Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury. Other studies have cautioned that the use of NSAIDs during ultra distance exercise is associated with an increased risk of exertional hyponatremia.
Aspirin is classified as an NSAID, but has some unique properties. Aspirin is a pain reliever that reduces inflammation and fever. It has also been shown to help prevent heart attacks, and may well have other long-term benefits, including reducing colon cancer risk. It acts as a blood thinner and, therefore, can prevent blood clots. Aspirin is nonaddictive.
Aspirin does have some risks. It should not be taken by children under 16 who have chickenpox or flu symptoms, due to the risk of Reye's syndrome. It is also not recommended for those with stomach problems, ulcers, kidney disease, bleeding disorders or aspirin allergies.
Topical Pain Medications, Sports Creams and Gels
Topical pain medications are those that are applied directly to the skin. They come in a variety of forms including creams, gels lotions and patches. There are three major categories of topical pain relievers, but the ones athletes use most (Bengay, Aspercreme and Sportscreme) contain salicylates (methyl salicylates), the same ingredients found in aspirin. They are effective pain relievers that also reduce inflammation when absorbed by the skin and used appropriately, but have some risks. Read more about sports creams
Acetaminophen (Tylenol and Panadol) is believed to act on the pain centers in the brain. They are the safest pain relievers because they don't block prostaglandins, and therefore don't cause any GI (gastrointestinal) bleeding. Acetaminophen reduces pain and fever, but not inflammation. It is ideal for treating osteoarthritis, or treating those with high blood pressure. High doses of acetaminophen may damage the liver, and rare reactions have been seen, such as rash and urinary problems. NSAIDs should not be taken by pregnant women (Always check with your doctor about pain relief during pregnancy).
What's the Best Pain Reliever for You?
As always, talk to your doctor before you take a pain reliever. If you take medications for any other medical condition (such as high blood pressure, arthritis, diabetes, ulcer or even acne) it's a good idea to ask about and understand the possible interactions and side effect. Be sure to tell your doctor and pharmacist about any other medications or supplements you are taking before you add any pain relievers.
If you do take an over the counter pain medication, be sure to follow the directions closely. In general, Ibuprofen (Advil, Motrin), Naproxen sodium (Aleve) or ketoprophen (Orudis KT) are helpful for those suffering from a sports injury that results in pain, swelling and inflammation. Generic brands work in the same way and must meet the same standards as the brand name equivalent, but cost less. Read and follow the label directions and don't take more that the recommended does. Also, don't use any OTC drugs for more than 10 days, unless your doctor or pharmacist tell you it's OK to do so.