Pain Relievers – What’s the Difference?

NSAIDs, Acetaminophen, Aspirin, Oh my! What’s the difference between the numerous pain relievers, and how do I choose the right one for me and my family?

Pain Relievers: What’s the Difference?

Non-prescription pain relievers come in so many different types and so many different brands types; how can I choose the best one for my pain, inflammation or fever?

Aspirin, the oldest and most common pain reliever available without a prescription, is not our only option nowadays. There are lots of alternatives, each with its own benefits and side effects. Choosing the best one for your circumstances is more than a matter of remembering which TV ad you noticed, or which sports celebrity endorser you like the most. Using the wrong pain reliever, or using too much of the right one, could place you at risk of some serious negative consequences, short- and long-term.

Over-the-counter pain relievers are broadly divided into two categories, depending on whether they act to suppress inflammation. The larger group is Nonsteroidal anti-inflammatory drugs, usually referred to as NSAIDs:

Aspirin (acetylsalicylic acid) is based on plant extracts that humans have used for thousands of years, and was first synthesized in the late 1700s. The German pharmaceutical manufacturer Bayer began marketing it under the name Aspirin in 1899. The most popular NSAID worldwide, aspirin is used for pain relief, and fever reduction, and as a blood thinning agent to help prevent damage from heart attack and stroke. Adverse effects include damage to the digestive tract, and interaction with anti-diabetic drugs and blood thinners like Coumadin. Aspirin is sold as a generic, and also under the brand names Bayer, Bufferin, Anacin and many more.

Ibuprofen and Naproxen are effective pain and fever reducers, a bit less likely to upset the stomach, although Naproxen brings slightly more risk of stomach ulcer. Ibuprofen is available as a generic product, and under the brand names Advil, Motrin, Nuprin and others. Naproxen is sold as a generic, and under the brands Aleve and Naprosyn, among others.

Alternative to NSAIDs: Acetaminophen.

Acetaminophen is effective for pain relief, but has little anti-inflammatory or fever reducing effect. The main benefit of acetaminophen over NSAIDs is that it is easier on the stomach. It’s often combined with opioids in prescription medicines that fight severe pain. Drawbacks include the potential for liver damage, which may occur from long term usage of small to moderate doses of acetaminophen. Drinking alcohol with Acetaminophen can also cause liver damage. Here’s the side effects alert as it appears on the Medline Plus web site operated by the Health & Human Services affiliate U.S. National Library of Medicine:

“Taking too much acetaminophen can cause liver damage, sometimes serious enough to require liver transplantation or cause death. You might accidentally take too much acetaminophen if you do not follow the directions on the prescription or package label carefully, or if you take more than one product that contains acetaminophen.”

All these medicines are available as low cost generics that work as well as the brand name versions. Aspirin, especially when used daily on doctor’s orders for blood thinning, is best used in a coated or buffered version to avoid stomach damage.

It’s not a good idea to take aspirin with other NSAIDs, because of the chance of blood clots. Be sure to ask your doctor for guidance before combining aspirin and NSAIDs.

Six things to consider when choosing a nonprescription pain reliever:

  1. What’s the difference? NSAIDs help with pain, lower fever, and help reduce inflammation. Acetaminophen eases pain and fever, but does not affect inflammation.
  2. Take your daily aspirin before taking an NSAID for pain relief. If your doctor has you on a daily regimen of low-dose aspirin for your heart, and you also take an NSAID for pain or inflammation, timing is important, because the NSAID can interfere with the effectiveness of aspirin. Ask your doctor if it makes sense to take aspirin first thing in the morning, then wait 30 minutes before taking an NSAID. If you do take an NSAID first, wait eight hours before taking aspirin.
  3. Beware of rising blood pressure. All NSAIDs have the side effect of boosting blood pressure. Acetaminophen has also been shown to cause small hikes in blood pressure, in high doses and among women.
  4. Don’t go cold turkey. If you take an NSAID regularly, don’t stop suddenly. Sudden withdrawal can make it more likely that blood clots will form, which increases the chance of heart attack or stroke.
  5. NSAIDs can damage the kidneys and, in extreme cases, cause kidney failure. If you have unexplained nausea, loss of appetite, persistent itching or changes your urine output, contact your doctor.
  6. Go generic. Generic over-the-counter pain relievers are less expensive than their brand-name counterparts, and work just as well.