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Over-the-counter Pain Medication: What’s Available?


Whether you have stubbed your toe or twisted your ankle, getting relief is important. Deciding which category to use, acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), depends on many factors. Having knowledge about the two will allow you to make the right choice.

Cause of pain

When an injury occurs, the body responds in a characteristic manner. First, it releases inflammatory chemicals to increase blood flow and cause swelling of the injured tissues. Second, the chemicals activate nerve endings in the immediate area, which send messages to the brain. Finally, the brain interprets the messages as painful.

Targets of over-the-counter (OTC) pain meds

Acetaminophen (one brand is Tylenol) works by decreasing inflammatory chemicals (called prostaglandins) in the brain. It does not reduce these chemicals at the site of injury. However, lower prostaglandin levels in the brain leads to pain relief.

NSAIDs (common brands are Aleve and Advil) work by blocking the production of prostaglandins in the body. Therefore, it reduces swelling and increases blood flow at the injured site. Additionally, it decreases the activity of the nerve endings, causing fewer messages to be sent to the brain.

Despite similar actions, there are advantages and disadvantages to each type.

Advantages of acetaminophen

  • Safer in heart patients (previous heart attack, high blood pressure, high cholesterol).
  • Safe for use if you have a history of stomach ulcers or kidney disease.
  • No interactions with aspirin or other anticoagulant medications (warfarin, Xarelto, Pradaxa).

Disadvantages of acetaminophen

Acetaminophen can cause significant liver injury if taken at doses above the recommended 4,000 mg/day. Additionally, people with active liver disease or who consume alcoholic beverages while taking acetaminophen are at higher risk.

The FDA estimates over 600 medications containing acetaminophen are available. Therefore, you must read the labels of all medications when taking acetaminophen to prevent an accidental overdose.

Advantages of NSAIDs

Disadvantages of NSAIDs

NSAIDs have the risk of causing ulcers and inflammation of the lining of the stomach (gastritis). Therefore, careful monitoring for stomach pain while using it is important.

Patients with kidney disease, diabetes, or heart failure should contact their doctor before using. NSAIDs are more likely to cause kidney injuries in patients with these conditions.

Finally, NSAIDs can increase the risk of heart attacks and strokes. If you have cardiovascular conditions (high blood pressure) contact your doctor before using.

List of OTC pain relievers with brand names.

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