There are so many different pain medications out there now that are available without a doctor’s prescription for the treatment of what are called minor aches and pains that many people are confused about what they can and can’t take for different types of pain. This posting will try to sort out the various over the counter (OTC) medications.
Available OTC meds fall into two categories: NSAIDs, and acetaminophen (Tylenol and others). NSAID stands for non-steroidal anti-inflammatory drugs, meaning that they are not cortisone-type drugs, but do reduce inflammation. Since some degree of inflammation underlies most pain, they are used for many different types of pain.
NSAIDs include the venerable aspirin (ASA), as well as the more modern ibuprofen (Advil, Motrin IB and others), naproxen (Aleve), and ketoprofen (Actron). The OTC versions are all sold at half the strength of the prescribed forms of the same drugs. Therefore, to equal the strength of prescribed Motrin, it is necessary to take 2 Advils. All of them inhibit the formation of certain pain-producing inflammatory products in the body. All have somewhat similar side effects, the most common being a tendency to cause acidic stomach pain, which can lead to ulcer development. Allergic reactions can occur with all of them.
Aspirin must be avoided in children under age 18 who have a disease causing fever, because of the possibility of the severe, although rare Reyes syndrome. It also prolongs bleeding and reduces any tendency to clotting. It is commonly given for this effect to older people to reduce the risk of heart attacks. All (except ASA) potentially cause liver or kidney problems, but these are very uncommon, considering the millions of people who take such drugs regularly. I think that all the NSAIDs are about equally effective, but many people believe that one helps more than another, so try different ones until you find the best one for you. NSAIDs which do not cause acidic stomach pains (COX-2 inhibitors) are available, but only by prescription.
Acetaminophen does not inhibit the same enzymes, and is not associated with stomach irritation or Reyes syndrome. Therefore, it is usually used when children are in pain or have fever. Its worst side effect is on the liver, where it can cause a severe, occasionally fatal hepatitis. People with pre-existing liver disease or heavy drinkers should not use acetaminophen. Relatively small doses of acetaminophen, like 12 grams (the equivalent of 24 extra strength Tylenol), in one day can cause liver failure. Acetaminophen and NSAIDs can be safely taken together for more pain control if there is no contraindication to either of them.
Measures that relieve pain other than drugs should always be tried. The pain of sore throat, small abscesses or superficial infections is often reduced by hot soaks. In the case of sore throat, hot soaking means gargling with hot water or hot tea. I don’t believe that adding salt makes it work better. Sprains, tendon injuries or tendinitis, and muscle pulls will often benefit from icing, at least for the first 12-24 hours. It is best done immediately after the injury. A pressure dressing such as an Ace bandage will also stabilize a sprain and reduce pain and swelling. People with chronic headaches or other chronic pains can often be helped by hypnosis, but this requires learning the process from a professional.
Let me briefly run through some of the more common pains to illustrate what I generally suggest:
Headache: Aspirin or one of the other NSAIDs is what I usually advise. You can safely take the ibuprofen you received for the sprain if it has not expired. Ice packs are also sometimes helpful. I don’t believe that acetaminophen is as strong as the NSAIDs, but if it works for you, use it.
Premenstrual syndrome: The classical Midol preparations are acetaminophen with other ingredients to reduce bloating or enhance the acetaminophen effects. They are probably no better than extra-strength Tylenol. All the NSAIDs can be used for this to relieve the cramping. Anaprox is a classic for PMS, but requires a doctor’s prescription. Aleve contains the same NSAID.
Muscle pains/sprains: Muscle pain from an acute injury should usually be iced, then NSAIDs can be used. Elastic bandages often help. Chronic muscle pains such as low back pain, the trigger points of fibromyalgia, etc. will often benefit from moist heat followed by massage. NSAIDs are also used.
Tooth ache: This may require large doses of an NSAID to hold you until you get to the dentist, who will often prescribe something with codeine, not available OTC. Three to four Advils or other OTC ibuprofen may be taken once or twice to get you through the night.
Sore throat: Gargling hot liquid followed by acetaminophen or an NSAID.
Minor abscesses/superficial infections: Hot soaks along with an NSAID or acetaminophen. If any abscess is enlarging, an infection is spreading, or fever develops it requires prompt medical attention. For recurring abscesses under the arms or on the tthighs try to start hot soaking as soon as you feel the first twinges, and keep it up.
Stomach ache: Stomach pains require different treatments. As I mentioned above, NSAIDs will cause or aggravate acidic-type upper abdominal pains, like heartburn. These should be treated with antacids (Mylanta, Maalox, TUMS and others), and possibly with an acid suppressant like ranitidine (Zantac 75), cimetidine (Tagamet HB), and others. Like NSAIDs, these OTC acid suppressants are half the dosage of the prescribed versions. Crampy stomach pains associated with diarrhea which come on quickly may be due to a virus, stomach flu, or a bacterial infection. They are usually short-lived, lasting three to four days, and may be accompanied by nausea and vomiting. Antidiarrheals like Imodium AD will reduce diarrhea and cramping. They should not be used for bloody diarrhea, which requires a visit to your doctor. Similarly, chronic abdominal pains and cramping should be investigated by your doctor. Whenever diarrhea or vomiting is present, fluids should be pushed.
I always advise people to shop around for the cheapest variety of drug available. Taking Advil or Aleve on any regular basis can start to add up. There may be a generic brand of ibuprofen 200mg in your drug store which will be just as effective as Advil. If you know you are going to be using an NSAID regularly, say for PMS, it often pays to get a presciption generic, such as full strength ibuprofen or naproxen from your doctor with many refills, rather than buying the OTC varieties of the same drugs.