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The difference between over-the-counter pain relievers

Published: February 10, 2023

Written by: Lauren Arcuri

Young woman and older man paddling in a canoe on a river.

Learning over-the-counter lingo may help you make the best choices for you and get the relief you need.

In this article:

Whether it’s the throb of a headache, the sting from a minor burn or the pang of a cramp, daily discomforts can drive us to seek relief. But which over-the-counter (OTC) product should you choose? What’s the difference between acetaminophen and ibuprofen? How do you decide what will work best for your type of pain? Are there drug interactions with anything else you take that you need to know about?

What are OTC pain relievers?

OTC pain relievers are medicines you can buy at a store or online without a prescription. They may help ease all sorts of pain — aches from cold and flu, arthritis, back pain, earaches, headaches, toothaches and more. Not all relievers work the same way, and depending on your health conditions, you may need to avoid certain products.

It’s always important to discuss any medications (even OTC) with your health care provider. How much and how often you take them and how they might interact with your particular medical conditions can influence how safe or risky they might be. Here’s a closer look at some of the most common OTC pills — and how they may impact your health.

What is acetaminophen?

Often sold under the brand name Tylenolacetaminophen has two main benefits: relieving pain and reducing fever. “We don’t fully understand how it works in the body,” says Gary Schwartz, MD, FASA, director of AABP Integrative Pain Care in Brooklyn, New York, but in the brain, it’s believed to block the enzymes that signal pain.

Example: Tylenol Extra Strength Caplets 500 mg Acetaminophen

When to be cautious: Because acetaminophen is processed by the liver, unintentional overdose can cause liver damage. Your risk increases the more you take or if you pair the drug with alcohol use. Best practice is to adhere to the daily limits on the bottle, and if you are being treated for any liver issues, check with your health care provider first, says Samer Narouze, MD, PhD, chairperson of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio.

What are NSAIDs?

There are three popular kinds of non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen (sold under brand names Advil and Motrin), naproxen sodium (sold under the brand name Aleve) and aspirin. These medicines all work in a similar way to relieve headaches, menstrual cramps, muscle aches and stiffness. They block the production of hormone-like substances called prostaglandins, which can irritate nerve endings and create the sensation of pain, as well as inflammation, swelling and fever.

However, there are some subtle and important differences:

  • Ibuprofen offers a shorter window of pain relief. It’s generally taken every four to six hours, and it’s approved for children over six months old. Example: Advil Coated Tablets Pain Reliever And Fever Reducer Ibuprofen 200mg

  • Naproxen sodium is longer-lasting than ibuprofen, requiring only one or two doses daily. It’s not approved for use in children under 12 years old without a prescription. Example: Aleve Headache Pain Tablets

  • Aspirin, like ibuprofen, is typically taken every four to six hours for pain and fever. It’s also “especially good” at treating headaches, says Dr. Schwartz. Because aspirin has been shown to inhibit blood clots, your doctor may recommend taking a low dose each day if you are at a high risk of heart attack — although this practice is not recommended for the general population. In most cases, children under 18 years old should not be given aspirin due to possible brain or liver damage (unless recommended by a healthcare professional). Example: Genuine Bayer Aspirin 325 mg Coated Tablets

When to be cautious: All NSAIDs can lead to stomach upset, bleeding or ulcers, says Dr. Schwartz, particularly if they are taken for an extended time. NSAIDs can also cause kidney damage, and non-aspirin NSAIDs carry a risk of stroke or heart attack. “These medicines are better avoided by patients with kidney disease, peptic ulcer disease, high blood pressure, bleeding disorders, or who take blood thinners,” says Dr. Narouze. NSAIDs are typically not recommended during pregnancy, because certain doses may increase the risk of complications.

What are combination drugs?

Approved by the Federal Drug Administration (FDA) in 2020, some products combine acetaminophen and ibuprofen — at lower doses than if they were taken individually — into one pill. “There are recent studies that show they’re even more effective together,” says Dr. Schwartz. The two drugs work in tandem to combat minor aches and pains like arthritis pain, body aches, headaches, menstrual cramps and toothaches. Example: Advil Dual Action Coated Caplets with Acetaminophen

When to be cautious: There are potential downsides to a dual-action medication. Since these pills contain both acetaminophen and ibuprofen, it’s possible that the risks associated with both medications may apply. Melissa Houser, MD, a family physician at All Brains Belong VT in Montpelier, Vermont, says, “As a general rule, I’m cautious about combination products. It’s easy to inadvertently take a medication that may not be safe for that person. It also makes it more challenging to isolate which medication to blame for a side effect — or to credit with a positive impact.”

Are gel caps or tablets better?

Most pain medications come in both traditional tablet formulations and gel capsules. How do you know which one to pick? “They both work,”says Dr. Schwartz, “although some patients find the gels easier to swallow. The downside is they are often more expensive.”

How to choose the best OTC pain reliever

There’s no one-size-fits-all option. The concept of the “strongest” OTC painkiller is up for debate—some people respond better to different medicines. When considering an OTC pain medication, bear in mind that just because a medication is available without a prescription doesn’t mean it’s without risks. OTC pain relievers have their place, but says Dr. Houser, “just as with any medication, the risk-benefit ratio needs to be considered within the big picture of someone’s health profile.” And overdoses in some cases can be fatal.

It’s also important to seek medical advice if you’re taking an OTC pain reliever for a new pain problem, because you might just be masking a potentially serious health issue. In general, it’s recommended to use OTC pain relievers for only a few days. “If symptoms persist, seek medical care,” says Dr. Narouze.

This content is for informational purposes only and is not medical advice. Consult with your health care provider before taking any vitamins or supplements, and prior to beginning or changing any health care practices.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.