Common over-the-counter painkillers: Doctors discuss different uses and risks

Pain relief is a common need in many households, with most people having a stash of painkillers tucked away for surprise headaches or stubborn cramps. However, not all painkillers are created equal, and they don’t all treat the same kind of pain.

There are two main categories of over-the-counter (OTC) pain relievers, as explained by MedLine Plus. The first category is NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen. Dr. Jessica Oswald, MD, MPH, an anesthesiologist and pain management specialist at UC San Diego Health, noted that NSAIDs reduce both pain and inflammation, but can irritate the stomach if not taken with food. The other category is acetaminophen, which helps with pain and fever but does not reduce inflammation.

Dr. Min \”Frank\” Wu, a physician at AdventHealth in Littleton, Colorado, explained how these drugs work differently in the body. NSAIDs are effective in treating fever and pain relief by inhibiting cyclooxygenase enzymes throughout the body, which inhibits the production of biological mediators that cause inflammation and blood clotting. Acetaminophen works by inhibiting COX enzymes and modulating the endocannabinoid system in the central nervous system to exert its effects.

Acetaminophen is effective for migraines and is recommended as a first-line agent by many European agencies. However, it is not clinically important for arthritic pain or low back pain. The combination of acetaminophen and NSAIDs has been shown to be more effective than either medication alone.

While NSAIDs and acetaminophen are generally safe, they do come with risks. NSAIDs can cause gastrointestinal issues, ulcers, bleeding, kidney impairment, heart disease, and liver damage at high doses. On the other hand, acetaminophen has been linked to potential liver injury, allergic reactions, and rare but serious skin reactions.

It is important to consult with a healthcare professional before using NSAIDs, especially for individuals with kidney problems, heart issues, or stomach ulcers. Acetaminophen is generally safer as long as the daily dose stays under 3,000 milligrams.

Ultimately, it is advisable to keep both types of OTC medications on hand at home to manage pain more effectively by targeting it in different ways. However, if pain persists or worsens, it is best to consult a healthcare professional to assess the cause and discuss other treatment options, including prescription medications.