Mar 1, 2004 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

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Pain Relievers: Understanding Your Options

Am Fam Physician. 2004 Mar 1;69(5):1199-1200.

What kinds of pain relievers are available over-the-counter?

Over-the-counter (OTC, for short) medicines are medicines that you can buy without a prescription from your doctor. OTC pain relievers for adults can be divided into two groups: acetaminophen (one brand name: Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs, for short).

NSAIDs include aspirin, ibuprofen (one brand name: Motrin), ketoprofen (brand name: Orudis KT) and naproxen sodium (brand name: Aleve).

Some products contain both aspirin and acetaminophen (one brand name: Extra Strength Excedrin). You should tell your doctor if you are using acetaminophen or any NSAID regularly.

Topical pain relievers are creams, lotions, or sprays that you put on your skin to relieve pain from sore muscles and arthritis. Some examples include Aspercreme, Ben-Gay, and Zostrix.

Some of these contain a medicine like aspirin, but there is no evidence that putting aspirin on skin works. Other topical medicines "mask" the feelings of pain by making the skin feel warm or cold. Others block the "pain message" from reaching the brain.

These topical medicines generally are safe, even with long-term use. They may be an alternative for people who cannot or do not want to use pills to relieve pain.

What is the difference between NSAIDs and acetaminophen?

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can reduce inflammation (swelling and irritation).

Will an OTC medicine work as well as a prescription one?

For most people, OTC medicines are all they need to relieve occasional pain.

If an OTC medicine does not help your pain or fever, call your doctor. If you have been taking an OTC medicine for more than a couple of days for fever or a couple of weeks for pain, call your doctor. These may be signs that you have a more serious problem or that you need a prescription medicine.

Do OTC pain relievers have any side effects?

All medicines can have side effects. However, side effects are usually not a problem for healthy people who only use pain relievers once in a while. Side effects can be a concern for people who regularly use pain relievers or have health problems. If you have questions about side effects, talk to your doctor.

Acetaminophen may be harmful in people who take very high doses or who frequently drink alcohol. With long-term use, aspirin and other NSAIDs may cause stomach upset, bleeding in the stomach and intestines, and ulcers.

Which OTC pain reliever should I choose?

The following advice is for healthy adults who only need a pain reliever once in a while. If you have health problems or regularly use pain relievers, talk to your doctor before you choose a pain reliever.

Acetaminophen and NSAIDs work for minor aches and pains, and for fever.

Acetaminophen, ibuprofen, and aspirin work well for occasional headaches and other common aches and pains. You should not give aspirin to children.

Ibuprofen is helpful for menstrual cramps and pain from inflammation (such as muscle sprains). If ibuprofen is not working for you, naproxen and ketoprofen might help.

What should I look for on the label?

When choosing an OTC pain reliever, check the label for possible side effects or to see if the pain reliever might cause problems with other medicines you are taking. Always read and follow the directions on the label carefully. If you have any questions, ask your doctor or pharmacist.

Who should not take acetaminophen?

Unless it is prescribed by your doctor, you should not take acetaminophen if you:

Have severe kidney or liver disease.

Have three or more drinks containing alcohol (even beer or wine) a day.

Who should not take NSAIDs?

Unless they are prescribed by your doctor, you should not take NSAIDs, especially aspirin, if you:


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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