Matching the pill to the pain
Tuesday, April 15 2008, 04:38 AM EDT
Contributed by: R.J. Ignelzi
COUNTER ATTACK
It's 2 in the morning and you wake up hurting with - pick your pain - a headache, backache, toothache or menstrual cramps. You look in the medicine cabinet in search of relief and the over-the-counter regulars stare back at you: aspirin, ibuprofen, naproxen and acetaminophen, along with a couple of combination medications that are supposed to help you sleep and ease your migraine.
Now, your pain is compounded by confusion.
Which one is the right one? Which pain reliever will work quickly, safely and not produce more problems than you started with?
American consumers love to have choices, but when it comes to pain relief, we just want something that works fast, effectively and without troublesome side effects.
"Although we're lucky to have these options at our fingertips, drugs that are usually very safe, cheap and beneficial in relieving pain for many people, it can sometimes be confusing," says Dr. William Norcross, chief of family medicine at the University of California San Diego Medical Center.
"Go with the one that works best for you," he continues, noting that it's important to consider your individual circumstances, pre-existing conditions and the risks of each medication.
"Over time, you'll find out which of these over-the-counter drugs does the best job for you and your (particular pain)," he says. "Stick with that one."
San Diego doctors look at the advantages and disadvantages of each of these OTC pain relievers and which is most effective for certain common ailments.
TYPES OF PAIN
ASPIRIN
You may know it as: Bayer, Aspergum
Pros: Effective pain reliever and anti-inflammatory drug. Cheap. Thins the blood so it's protective against heart attacks and stroke.
Cons: Can be irritating to the stomach. Has a short shelf-life, so you need to take it every four hours, which increases the risk of stomach problems. Large doses may cause tinnitus, ringing in the ears.
Contraindications: Aspirin should not be taken by children under 18 because of the risk of Reye's syndrome, a rare but very serious liver and central nervous system condition.
People with asthma should consult their doctor before taking aspirin since there's "a strong correlation between asthma and aspirin and other nonsteroidal anti-inflammatory drugs," says Dr. Davis Cracroft, medication safety officer and emergency physician at Scripps Mercy Hospital. Shouldn't be taken by people with stomach ulcers or with a history of internal bleeding.
Not recommended for pregnant or breast-feeding women.
Note: All of the nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen and naproxen, can cause stomach and GI tract irritation. To reduce this risk, take with food or as an added measure take with stomach-protecting drugs such as Prilosec, Zantac or Tagamet.
IBUPROFEN
You may know it as: Advil or Motrin
Pros: Good anti-inflammatory medication. Generally safe and cheap. Doesn't need to be taken as frequently as aspirin, usually every six hours.
Cons: Does not offer the same cardiovascular protection that aspirin does. Can irritate the stomach and GI tract. May increase the risk of heart attack or stroke, especially for those who have taken it for a long time.
Contraindications: People shouldn't use ibuprofen if they have a history of bleeding disorders or if they have stomach problems or an ulcer. Prolonged use may cause kidney problems.
As people get older, it's recommended they lessen the dose of ibuprofen since, if taken regularly or in high doses, it can cause high blood pressure, Cracroft says.
Not recommended for pregnant women and only short-term use for breast-feeding women.
NAPROXEN SODIUM
You may know it as: Aleve or Naprosyn
Pros: Very good anti-inflammatory drug. Usually safe and cheap. Only needs to be taken every eight to 12 hours.
Cons: Can be very irritating to the stomach and GI tract. Does not offer cardiovascular protection. May increase the risk of heart attack or stroke, especially for those who have taken it for a long time. Prolonged use may cause kidney problems.
Contraindications: People shouldn't use naproxen if they have a history of bleeding disorders, stomach problems or an ulcer. Not recommended for pregnant or breast-feeding women.
ACETAMINOPHEN
You may know it as: Tylenol
Pros: One of the safest pain relievers and fever reducers. No adverse effects on the stomach or GI tract. Safe for children. The safest pain choice if you also take a daily aspirin to protect your heart. Safe for pregnant women.
Cons: When taken regularly or in high doses, it can cause injury to the liver or liver failure. Not an anti-inflammatory drug.
Contraindications: Don't take if you have liver disease. People who consume more than two alcoholic drinks a day should not take acetaminophen because of risk to the liver. People with healthy livers should take no more than 4,000 milligrams a day (about eight tablets).
Since acetaminophen is often compounded in other types of drugs, including cold medications and narcotic drugs, it's important for regular acetaminophen users to read ingredient labels and talk to your doctor before taking other medicines.
Migraine pain relievers:
Products such as Excedrin Migraine are a mixture of acetaminophen, aspirin and caffeine. The pain of migraines is caused by the dilation of the arteries, and caffeine helps constrict those arteries, Norcross explains. If you're very sensitive to caffeine, beware of taking these migraine medications at bedtime.
Pain relievers with sleep-aid:
Pain meds such as Tylenol PM and Advil PM contain the drug diphenhydramine, commonly known as Benadryl, which acts as a gentle sleep aid for some people. Norcross cautions about taking too much or using the product if you're already taking an antihistamine for allergies or a cold. It can dry you out, resulting in constipation, urinary retention, dry eyes and dry mouth.
Erin Hobbs contributed to this article.
SIDEBAR
Good for what ails you
Here are the over-the-counter pain relievers doctors often recommend to help ease 10 common aches and pains.
HEADACHE
First choice: Acetaminophen. Pain relievers that also offer caffeine may offer added benefit. Second choice: Aspirin or ibuprofen
EARACHE First choice: Acetaminophen. Second choice: Ibuprofen
BACKACHE First choice: Ibuprofen. Second choice: Acetaminophen or naproxen
MENSTRUAL CRAMPS First choice: Ibuprofen. Second choice: Naproxen
FEVER First choice: Acetaminophen. Second choice: Aspirin (but never for children under 18 years)
TOOTHACHE First choice: Ibuprofen. Second choice: Alternate ibuprofen with acetaminophen until you get to a dentist.
SUNBURN First choice: Ibuprofen. Second choice: Acetaminophen
OSTEOARTHRITIS PAIN First choice: Acetaminophen. Since this is a chronic condition and medication must be taken long term, acetaminophen offers the safest relief. Second choice: Ibuprofen or naproxen
MUSCLE STRAIN (overuse) First choice: Acetaminophen. Second choice: Ibuprofen or naproxen
MINOR SPRAIN First choice: Ibuprofen is especially good if there's swelling, plus the usual - rest, ice, compression and elevation. Second choice: Acetaminophen (Consult your doctor before taking any medication.)
- R.J. Ignelzi
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