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.
