Which Over-the-Counter Pain Medication Is Best?

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Deciding on a pain reliever can be tough. Advertisements that tout one drug’s advantages while slamming the competition are about as objective as political commercials.

For treating fever, headaches or routine aches and pains, different over-the-counter (OTC) painkillers are of similar effectiveness. But there are important differences.

• Aspirin

Aspirin is the least expensive OTC painkiller. But it’s also the most likely to cause stomach upset. This can range from trivial indigestion to life-threatening hemorrhages.

No doubt you’ve heard that low doses of aspirin, taken regularly, help prevent heart attack and colon cancer. While aspirin does offer some protection against these ailments other pain relievers don’t it also appears to raise the risk of bleeding into the brain (hemorrhagic stroke).

Aspirin therapy to prevent heart attacks is appropriate for people over age 50 with cardiac risk factors (high blood pressure, high cholesterol, etc.) Of course, you should check with your doctor.

  • Ibuprofen

Ibuprofen (Advil, Motrin) and other newer nonsteroidal anti-inflammatory drugs (NSAIDs) are less likely than aspirin to upset the stomach. Ibuprofen is especially good for menstrual pain. But these drugs including naproxen (Aleve) and ketoprofen (Orudis KT) are by no means perfectly safe.

Each year, an estimated 10,000 Americans are hospitalized for intestinal bleeding caused by newer NSAIDs. One thousand die of such bleeding. These drugs can also cause kidney problems and reduce the effectiveness of some blood pressure medicines

• Acetaminophen

Acetaminophen (Tylenol) is probably the safest OTC pain pill. But it’s not entirely harmless. As Advil commercials correctly point out, drinking more than three alcoholic beverages a day while taking acetaminophen can cause liver damage. But if you drink that much alcohol and take ibuprofen or aspirin, your risk of a fatal intestinal hemorrhage also climbs.

For certain individuals, some drugs are better choices

  • Anyone with a history of ulcers should avoid aspirin and other anti-inflammatory drugs. Acetaminophen is usually a better choice.
  • Anyone with chronic hepatitis or another liver problem should avoid acetaminophen. Aspirin or ibuprofen is better.
  • Heavy drinkers should avoid regular use of all pain relievers. If one is needed, it should be taken at the lowest effective dose and taken as infrequently as possible. Of course, the best bet is to cut back on drinking.
  • Elderly people should generally stick to acetaminophen for treating minor aches and pains. Taking aspirin to prevent heart attack is a separate matter one that should be discussed with a doctor.
  • For children, acetaminophen and ibuprofen are safer than aspirin. When kids with influenza are given aspirin, they can develop a devastating illness called Reye’s syndrome.

Whichever pain pill you choose, remember to use it sparingly. All drugs cause side effects.

If you do need a pain pill, forget all the marketing hype. Generic aspirin, acetaminophen and ibuprofen are every bit as effective as Bayer, Tylenol and Advil.

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