High doses of NSAIDs create the risk of ulcers, unwanted bleeding and kidney damage. Acetaminophen, with alcohol, can damage the liver.

Prostaglandins are a major trigger of menstrual cramps, so ibuprofen or any of the NSAIDs should offer a suitable remedy.

Gripping pain, gnawing pain, stabbing pain, throbbing pain, the dull, persistent pain of fatigue and overwork. Headache, aching muscles, tooth ache, menstrual cramps, lower back pain, arthritis, cancer pain.

Pain is a fact of life. Fortunately, for all but the most severe cases, there are medications available to relieve the misery.

It’s important to remember that pain is the body’s way of warning us that something is not right. Any time you have severe pain or pain that does not go away, you should see a doctor right away. Pain associated with surgery or a medical disorder such as arthritis or cancer should be managed by a prescription from your doctor, and it’s important to follow the directions. Controlling the pain and inflammation is an important part of the overall treatment.

For the garden variety, every day aches and pains–headaches, tennis elbow or a twisted ankle–there are numerous over-the-counter medications available, and the ad writers will try to direct you to the product they’re selling. It’s better to make an informed choice.

The first step is to distinguish between acetaminophen (Tylenol) and the nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin.

Anti-Inflammatory or Not?
Acetaminophen works by inhibiting the pain impulses in the brain and central nervous system. NSAIDs, as their name suggests, are anti-inflammatory. They inhibit enzymes that produce prostaglandin, a key player in the inflammation that occurs at the site of an injury–the swelling, warmth and redness that are at the source of much of the pain. In addition to aspirin, NSAIDs include ibuprofen (Advil, Motrin, Nuprin), ketoprofen (Orudis KT, Actron) and naproxen (Aleve).

When it comes to reducing fever or relieving headaches, toothaches, joint or muscle pain, any of these medications can be effective, and many popular pain killers include a combination of ingredients. Excedrin-type formulations, for example, contain a blend of aspirin, acetaminophen and caffeine. Anacin combines aspirin and caffeine–without the acetaminophen. In addition to adding its own pain-killing properties, caffeine speeds absorption of the medicine so that it gets to work faster.

These combination drugs work for many people, but don’t try putting together your own blend. You may end up with something you don’t want or need.

If you see “buffered” on the label, it means that an antacid has been added. Studies have indicated that the quantity of antacid added to such products is not enough to really protect the stomach, but it does make the pill dissolve faster. Enteric-coated tablets, on the other hand, may be less likely to affect your stomach but will take about 15 minutes longer to start working.

Time-release capsules take longer to dissolve but may have a longer-lasting effect. PM on the label means an antihistamine has been added to help you sleep better.

Which OTC remedy is best depends mostly on your personal preferences and your experiences with that medication.

Ibuprofen was initially introduced as a remedy for menstrual cramps and is still considered the gold standard treatment. Prostaglandins are a major trigger of menstrual cramps so any of the NSAIDs should work equally well.

If you’re physically active, you’ve undoubtedly become accustomed to numerous aches and pains. It’s important to deal with these early so they don’t develop into more serious problems.

Ice is the most effective treatment for pain and inflammation. And any persistent pain is a sign that you need to rest that muscle or joint until you can exercise without pain.

Some doctors and trainers believe that judicious use of NSAIDs may also help reduce the swelling and improve the range of motion so that healing can take place more effectively. If there’s bleeding or bruising (a sign of internal bleeding), however, acetaminophen is recommended since any of the NSAIDs will aggravate the bleeding. And whichever medication you take, it’s important to stay within the label guidelines or else to see a physician.

The maximum dose of ibuprofen, for example, is 1200 milligrams in a 24-hour period, and this amount may not be enough if you’ve got a seriously inflamed shoulder or elbow. Some studies indicate that the anti-inflammatory benefits of this drug start kicking in at about 1600 milligrams per day, and doctors may prescribe this level or higher–but only under medical supervision.

High doses of NSAIDs can greatly reduce the stickiness of blood platelets, creating the risk of stomach ulcers or other internal bleeding problems. Of the 13 million Americans who regularly take over-the-counter NSAIDs, about 76,000 each year end up in the hospital from bleeding ulcers and about 10 percent of these die.

Another potentially dangerous side effect is kidney damage. Athletes are particularly vulnerable since their kidneys may be already overtaxed due to dehydration. One runner who took excessive quantities of NSAIDs before, during and after the Boston Marathon developed kidney failure 48 hours after the race and required dialysis for six months to recover.

It’s important even at normal doses to take NSAID pills with some food and a full glass of water and to make sure you get plenty to drink throughout the day. Never take them just before, during or just after a vigorous workout or one in hot weather that’s likely to leave you dehydrated. Alcohol and caffeine are basically diuretics, and air travel can also be dehydrating.

If you’re on blood-thinning heart medications such as coumadin or warfarin or if you take herbal supplements such as ginkgo biloba, NSAIDs can cause unwanted bleeding. They may also raise blood pressure in some individuals or counter the effectiveness of BP medications. It’s best to check with your doctor before taking even recommended doses for any length of time or more than two or three times a week.

While acetaminophen has none of the above effects, it comes with its own risk profile. Serious liver problems can and have occurred when regular, though moderate, drinkers took only slightly more than the recommended dose. If you drink more than three beers a day or the equivalent, acetaminophen may be risky.

All complications are rare, of course; otherwise these drugs would not be approved for over-the-counter sale. If you want to soothe a headache, ease menstrual cramps or quiet a pain in your big toe or elbow, there are many readily available medications that will do the trick. If your pain is bad enough that you feel like popping pills, it’s time to see your doctor.

REFERENCES:
Nigel Hawkes, “Painkillers May Need To Be Sex Specific,” British Medical Journal, February 26, 2000.
Arthur Levin, “Popular Painkillers Risky to the Heart,” HealthFacts, April, 2000.
Peggy Morgan, “Relieve Pain Now. How To Find the Perfect Painkiller without Spending 2 Hours in Aisle 12,” Prevention, July, 1997.
“Painkillers Plus These Drugs Don’t Mix,” Prevention, October, 1998.
Jim Thornton, “If the Pain Doesn’t Kill You...the Painkillers Might,” Women’s Sports and Fitness, May, 2000.
“What Are Nonsteroidal Anti-Inflammatory Medications (NSAIDs)? WebMD, copyright Cleveland Clinic, 1999.