Making sense of all the pain relievers spilling off store shelves today is, well, enough to give you a headache.

Here's a little secret to ease the confusion: Despite the growing choice of products -- the medicinal equivalent of a crowded cereal aisle -- the experts say there is very little new when it comes to over-the-counter (OTC) pain relievers. It's the same pain-killing theme, different variation, says Mary Lea Gora Harper, Pharm.D., director of the University of Kentucky's Drug Information Center.

The multi-million-dollar ad campaigns only add to the confusion.

"Everybody is trying to make their drug look different," Dr. Harper says. "But when you come down to it, there isn't a big difference in the effectiveness of these drugs."

OTC pain relievers fall into two categories: nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs include aspirin, naproxen, ketoprofen and ibuprofen.

The U.S. Food and Drug Administration (FDA) says many OTC medicines contain the same active ingredient. If you take several medicines that happen to contain the same active ingredient -- for example, a pain reliever along with a cough-cold-fever medicine --    you might be taking double the dose you think you are getting. So read the label and avoid taking medicines that contain the same active ingredient or talk to your pharmacist or health care professional.


Whether it comes as a brand name or generic, this anti-inflammatory gums up the body's machinery for making prostaglandins, natural chemicals that send pain signals to the brain when you have fever, headache or inflammation. Aspirin is the oldest and has proven to be the safest of all the OTC pain medications. Besides relieving pain and fever, aspirin also helps prevent heart attacks. Cardiologists recommend that men older than 50 take a daily half dose of aspirin.


Best known as the brand-name Tylenol, acetaminophen works by traveling through your bloodstream to the brain, where it dulls the sensation of pain, says Victor Padron, Ph.D., a medication expert at Creighton University in Omaha, Neb. Acetaminophen is now the nation's most popular pain reliever, controlling about 30 percent of the $3 billion analgesic market. Unlike the other pain relievers, acetaminophen doesn't reduce swelling or inflammation. And it has its drawbacks, namely liver toxicity. In fact, acetaminophen is the leading cause of acute liver failure in the United States. If you take acetaminophen, follow the dosing instructions carefully. Do not take it for 24 hours before or after drinking alcoholic beverages.


NSAIDs are the most recent pain relievers to hit the OTC market. Chemically, they are similar to aspirin. Like aspirin, they block prostaglandin production and reduce pain, swelling and fever. The differences among them lie mainly in price and how often you need to take them.

Sorting through the crowd

Once you've got the three basic kinds of pain relievers straight, you've still got to make your way through the endless variations among similar pain pills. Here are some handy tips:

Generic advantage

All the non-prescription pain relievers are available in a generic form. "They are less expensive and there should be no difference from the brand-name version," Dr. Harper says. "There might be a slight difference in the inert fillers they use, but that's all."

Combination pills

Some pain relievers come mixed with drugs used to treat congestion or allergies. It's better to stick with a single-drug pill, even if that means taking two different medicines. That way, you get the maximum dose of pain relief, and you can control how often you take each drug.

Tablets, capsules, buffered, gel-coated?

These variations are meant to ease the stomach irritation and swallowing problems that sometimes go along with pain pills. They are usually more expensive than the simpler forms of the medication, Dr. Harper says. Find the form that works best for you, and stick to it, she advises.

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