Taking the Pain Out of Pain Relievers

By Robert Shmerling, M.D.
Content provided by the Faculty of the Harvard Medical School

Pain relievers must be among the most misunderstood types of medications out there. I get these questions all the time:

Can I take Advil if I'm also taking Aleve?

Can I drink if I'm taking aspirin? What about Tylenol?

I'm worried about my liver. Which pain reliever is safest? Will it harm my kidneys?

Pain relievers are confusing because:

  • There are so many different kinds.

  • Many of the same medicines are available with and without a prescription.

  • Some pain relievers are multi-purpose. It's hard to keep all of their uses straight. Take, for example, aspirin and acetaminophen. Not only are they useful as pain relievers and fever reducers, but aspirin is also used to prevent heart attacks and strokes.

  • Some pain relievers come with "baggage." They may be habit forming and even sold on the street. Many doctors have encountered individuals who will do or say anything to get certain pain relievers because they're addicted or because they plan to sell them.

For all of these reasons, it's important to understand what your doctor is saying about pain relievers. So what do you need to know so that pain relievers are less of a pain? Read on for a quick rundown.

Categories of Pain Relievers

To get the big picture, think about pain relievers in these broad categories:

  • Mild analgesics (pain relievers) – These are usually recommended for headaches or minor, everyday aches and pains.

  • Non-steroidal anti-inflammatory drugs (NSAIDs)Arthritis, dental pain and back pain are often treated with NSAIDs, especially if mild analgesics (such as acetaminophen) don't work.

  • Medications for neuropathy (nerve disease) – People with sciatica or diabetes may have nerve-related pain that responds to these medicines; increasingly, these are used for painful conditions other than nerve pain.

  • Muscle relaxants – Back or neck pain due to muscle tension or spasm may respond particularly well to these.

  • Narcotic analgesics – For severe pain, such as after surgery, narcotics may be recommended.

In general, the milder, safer medications at the top of this list are used before stronger medications at the bottom of the list. That's because the more powerful medications may not be necessary and tend to have more side effects.

While some medicines work best when taken regularly (rather than "as needed") for certain conditions, it's generally a good idea to take the minimum amount of pain medication for the shortest time possible.

If a pain medication provides minimal relief or doesn't work at all, it's probably a good idea to stop taking it. Just check with your doctor before stopping any medication he or she has recommended to you.

Advantages and Disadvantages of Each Type

Each type of pain reliever has its advantages and disadvantages.

Mild analgesics

The most famous member of this group is acetaminophen. As analgesics go, acetaminophen is among the safest. While it rarely works for severe, debilitating pain, acetaminophen can "take the edge off" of mild to moderate pain. For example, headaches, muscle soreness, or other minor aches and pains may respond well to intermittent or regular use of acetaminophen.

It's also a good medication to bring down fever. In fact, common advertisements for acetaminophen take advantage of this point: Ads boast that acetaminophen is "the most widely prescribed pain reliever in hospitals." While that may be true, much of the acetaminophen administered in the hospital is for fever, not pain.

Serious side effects are rare. High doses of acetaminophen can damage the liver. Long-term, high-dose use can cause kidney damage. Minor side effects include rash, itching or other allergic symptoms. Acetaminophen is not strongly associated with stomach pain, ulcers or bleeding.

Non-steroidal anti-inflammatory drugs (NSAIDs)

This category includes ibuprofen (Motrin, Advil, others), naproxen (Naprosyn, Aleve, others), and celecoxib (Celebrex). They counteract chemicals, called prostaglandins and cyclooxygenase, that are involved in the body's regulation of inflammation. As a result, they relieve inflammation and the pain it causes. In addition, NSAIDs are mild pain relievers, so they can work even when little or no inflammation is present.

Reference: Arthritis section on Better Medicine

Did You Know?

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Arthritis accounts for 39 million doctor visits each year and more than 500,000 trips to the hospital.