We’ve all had days with nagging headaches, muscle and joint soreness, or general aches
and pains, that don’t require medical attention, but require something to take the edge off
the pain.
That something is often an over-the-counter, or OTC, painkiller.
There are a variety of brands, which each have different active ingredients, so which
OTC painkillers are the best at decreasing pain?
In general, OTC painkillers can be classified in two categories: non-steroidal anti-inflammatory
drugs or NSAIDs and acetaminophen.
Inflammation and fever result from pro-inflammatory chemicals called prostaglandins, and NSAIDs
work by decreasing levels of these prostaglandins.
The most common OTC variations of NSAIDs include Aspirin which is found in brands like Bufferin
and Bayer; Ibuprofen, found in brands like Advil and Motrin; and Naproxen, found in Aleve.
NSAIDs are generally safe, but chronic use can irritate the stomach lining and cause
ulcers.
NSAIDs, are also believed to decrease blood flow through the kidneys which can lead to
kidney problems in people with other risk factors for kidney disease.
Similarly, while the mechanism isn’t completely clear, NSAIDs, with the exception of Aspirin,
can cause cardiovascular damage with extended use.
Finally, NSAIDs have been linked to developmental defects in fetuses so it’s generally recommended
for pregnant women to avoid NSAIDs, especially late in the pregnancy.
Unlike NSAIDs, it’s unclear how Acetaminophen exactly works, but it’s thought to block
enzymes in the brain and spinal cord that produce chemicals that promote pain and fever.
One key difference though, is that acetaminophen doesn’t decrease inflammation.
It’s found in hundreds of brands like Tylenol, and it’s commonly mixed with other active
ingredients as well.
Examples include Excedrin which works for migraines and is a mix of acetaminophen, aspirin,
and caffeine; and Vicodin, which is a prescription strength painkiller that contains acetaminophen
and hydrocodone bitartrate—a type of opiate.
Acetaminophen is generally safe to use, but using too much of it can harm the liver, especially
if you also drink a lot of alcohol or have existing liver issues.
Now, a common question is “how well do these OTC analgesics work?”
To help answer that question, a recent study looked at a number of studies that have been
done to compare how different painkillers decreased pain following wisdom teeth removal.
Keep in mind that pain varies so it may not be the same for things like migraines, tension
headaches, and menstrual cramps.
That said, there were some interesting findings.
The researchers plotted the number needed to treat, or NNT, for a variety of OTC painkiller
combinations.
An NNT of one, basically means that you would need to treat one person with the medication
for one person to see a benefit.
An NNT of 4 means that you would need to treat four people for one person to see a benefit
of using the drug.
So the lower the NNT the better the medication performed.
So based on the data, ibuprofen in combination with other medications like acetaminophen,
performed relatively well.
Interestingly, the combination of 200 mg of Ibuprofen with 500 mg of acetaminophen had
an NNT of 1.6 which means it worked almost as well as the combination 400 mg of Ibuprofen
with 1000 mg of acetaminophen which had an NNT of 1.5.
This means you can limit your dose of the medication while maintaining the benefits.
Another interesting finding is that both 200 mg and 400 mg doses of fast-acting formulations
of ibuprofen alone, which are designed to be quickly absorbed into the bloodstream,
and a combination of 200 mg of ibuprofen with 100 mg caffeine all had NNTs of 2.1 giving
you more options for relatively effective pain relievers if you’d like to avoid taking
acetaminophen.
On the other hand, aspirin and acetaminophen by themselves have much higher NNTs meaning
that they don’t perform as well.
Alright, as a quick recap … choosing the right over-the-counter painkillers can be
confusing.
While these drugs are safe at recommended doses taking too much acetaminophen can be
hard on the liver, and taking too many NSAIDs can cause stomach, kidney, cardiovascular,
and fetal development issues.
That said, if there are no reasons to avoid specific medications a combination of 200
mg of Ibuprofen and 500 mg of acetaminophen may be best for temporary pain relief.