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Pain relief guide: What to take when

With so many choices, here's how to figure it out

Last updated: April 2011

Photo: James Worrell

You probably have Tylenol, Advil, aspirin, and maybe some other pain relievers hanging out in your medicine cabinet, but when something hurts, which one should you reach for? They might seem interchangeable, but they're not. Certain drugs work better for specific kinds of pain, whether you're suffering from a headache, muscle aches, joint pain, or some other discomfort. For most minor ailments, an over-the-counter drug may be all you need.

Acetaminophen (Tylenol and generic), aspirin, ibuprofen (Advil, Motrin, and generic), and naproxen (Aleve and generic) are all inexpensive. (See When not to take these drugs.) And they're generally safe for occasional use for a headache or sore muscles. But prolonged use of ibuprofen or naproxen, which are known as NSAIDs (nonsteroidal anti-inflammatory drugs), can increase your risk of heart attack or stroke. With repeated use, all of these, including aspirin, can be tough on your gut, sometimes causing stomach bleeding and ulcers, and acetaminophen can cause liver damage. Those risks increase if you take higher-dose prescription-strength versions, which some people need to manage severe and chronic pain. Follow instructions about how much to take and how often. And keep in mind that you're better off trying to prevent pain than waiting to treat it, so be sure to read our prevention tips.

If you have a headache

Try this: Acetaminophen, ibuprofen, or naproxen

 

Why? For run-of-the-mill headaches, including tension headaches, acetaminophen is a good first line of defense. Using NSAIDs for the occasional headache probably won't increase your risk of heart attack or stroke, but be aware that you might risk stomach bleeding and ulcers. The risk is higher for people 60 and older, those who have had stomach ulcers or bleeding before, and those who have three or more alcoholic drinks each day while taking an NSAID. Overuse of them can cause "rebound" headaches.

 

Prevention tip. Drinking water to stay hydrated can prevent headaches.

If you have muscle soreness

Try this: Ibuprofen or naproxen

 

Why? For muscle aches, like the kind you get after an afternoon of tennis or your first jog in a while, those NSAIDs are good options to try first. You might also try over-the-counter pain-relief creams or specially made prescription-strength ones; they can help relieve pain directly at the source.

 

Prevention tip. Try stretching after you work out when, your muscles are warmed. And if you haven't done an activity in a while, don't overdo it.

If you have back, neck, or shoulder pain

Try this: Any OTC pain reliever

 

Why? Strong prescription medicines called muscle relaxants are often used to relieve the spasms and sore muscles that can be the culprits behind very painful backaches and neck pain and other conditions. But those drugs have risks that include addiction, sedation, fatigue, and dizziness. And our analysis shows that they don't work any better than OTC acetaminophen, aspirin, ibuprofen, or naproxen.

 

If you try one of the OTC drugs, be sure not to take it or any other pain reliever for more than 10 days without consulting a doctor. If you still have pain, or you can't take the OTC drugs because of bleeding ulcers or liver or heart problems, you might consider a asking your doctor for a muscle relaxant. Our Best Buy Drugs top pick is cyclobenzaprine (Flexmid, Flexeril, and Amrix). The generic drug costs $8 to $15 for a seven-day course, which makes it one of the least expensive options. Skip carisoprodol (Soma); it's associated with a higher risk of abuse and addiction than other skeletal muscle relaxants.

 

Nondrug treatments might help, too, including a heating pad, gentle exercise, massage, and yoga.

 

Prevention tip. If you sit in a chair for hours, exercises can help prevent stiffness and pain in your neck and back. Here's a good one to try: Push yourself away from your desk, put your elbows on your knees and your hands wherever they're most comfortable, and tuck your chin into your chest so that your back is rounded. Then reverse that position by arching your back. Hold and repeat each position eight times a day.

If you have a migraine headache

Try this: Acetaminophen, aspirin, ibuprofen, naproxen, or combination products that contain acetaminophen, aspirin, and caffeine (such as Excedrin extra Strength, Excedrin Migraine, and generic).

 

Why? Studies have found that those drugs help many people with migraines, especially if they're infrequent. If you think you have migraines—even if the drugs ease your pain—you should see a doctor for an accurate diagnosis.

 

If you suffer from moderate to severe migraines or average more than two migraines a month, you might do better with prescription drugs called triptans. Our top pick is generic sumatriptan, even though it's still fairly pricey, around $24 a pill. A few important warnings: Because triptans temporarily narrow blood vessels, they can increase the risk of heart attack and stroke and should not be taken by women older than 50 or men older than 40, people with an elevated risk of heart attack or stroke, diabetics, smokers, or those with uncontrolled high blood pressure.

 

Also, overuse can cause rebound headaches. Skip opioid-based pain relievers such as hydrocodone and oxycodone, which rarely work well on migraines and have their own risks.

 

Prevention tip. Work with your doctor to identify your triggers. Common ones include some cheeses; food additives such as MSG; alcohol; caffeine in coffee, chocolate, and tea; dehydration; getting too little or too much sleep; certain loud noises, lights, or odors; high altitudes; menstruation; plane rides and jet lag; skipping meals; and stress.

If you have joint pain

Try this: Acetaminophen, ibuprofen, or naproxen

 

Why? Those OTC medications are the most frequently prescribed treatment for joint pain. That common complaint frequently stems from osteoarthritis, a degenerative joint disease that causes pain, stiffness, and immobility. Try the recommended dosages for a few days (10 max); that might be all you need.

If you're still in pain, you might want to try a higher-dose prescription-strength NSAID. Check with your doctor.

 

Prevention tip: The best way to ward off joint pain, stiffness, and creakiness is keeping active and limber, which might eliminate or sharply reduce your need to take medicine. Try to get regular exercise, including strength training, and do a lot of stretching. Just be sure to talk to your doctor before you begin any exercise program.

If you have a hangover

Try this: Aspirin or ibuprofen

 

Why? Don't take acetaminophen for a hangover because it can cause liver damage, especially when mixed with alcohol. Instead, to calm a headache that comes the morning after drinking too much alcohol, take aspirin or ibuprofen. But make sure you eat something first so that you don't irritate your stomach lining.

 

A warning: If you usually have three or more drinks daily, you face an increased risk of stomach bleeding and ulcers.

 

Prevention tip: Drink lots of water or other nonalcoholic liquids while you're drinking alcohol and after, and be sure to eat. Opt for alcoholic drinks that are lighter in color; dark ones such as whiskey and red wine contain more congeners, a by-product of the fermentation process that can make you feel lousy the next day.

When not to take these drugs

Skip NSAIDS if you've ever had a stomach ulcer or intestinal bleeding or are at risk for them. Take acetaminophen, which is less likely to cause bleeding. Also, skip NSAIDs (except for aspirin—see below) if you have heart problems or high blood pressure because they can increase your risk of heart attack and stroke.

Acetaminophen or aspirin is generally a better first option for those with heart problems, such as heart disease, uncontrolled high blood pressure, or previous heart attack or stroke.

Skip acetaminophen if you regularly drink three or more alcoholic drinks per day; the combination increases the risk of liver damage. And never take more than the maximum daily dose. Even just a little more acetaminophen can be toxic and lead to liver failure.

Skip aspirin if you have any of the stomach problems that are listed under NSAIDs. That's because aspirin is also considered an NSAID, so it has the same risk factors for ulcers and stomach bleeding.

How much do they cost?

Store-brand versions of big-name drugs are equally safe and effective, and they can save you as much as 66 percent. We sent 23 of our secret shoppers to check the prices of three popular pain relievers at stores around the country. Here are the average prices they found on 100-count bottles of name- and store-brand versions, and how much the latter can save you. Not ready to switch? Target and Walmart have the best deals on name-brand pain relievers, saving you 15 percent or more.

Advil

Store Advil (200 mg) Store brand Savings
Walmart $8.44 $3.08 64%
Target 8.17 3.33 59
Rite Aid 9.99 7.17 28
CVS 9.91 7.24 27
Walgreens 9.79 7.38 25
Supermarkets 9.64 na na

Motrin

Store Motrin (200 mg) Store brand Savings
Walmart $8.24 $2.76 66%
Target 8.13 4.41 46
Rite Aid 10.07 7.46 26
CVS 9.96 8.14 18
Walgreens 10.12 7.17 29
Supermarkets 9.51 na na

Aleve

Store Aleve (200 mg) Store brand Savings
Walmart $8.38 $5.09 39%
Target 8.43 5.18 39
Rite Aid 10.07 7.94 21
CVS 10.15 7.97 21
Walgreens 9.94 7.96 20
Supermarkets 9.69 na na

When to try a cream

Sometimes it's best to attack pain right where it hurts. A topical NSAID is worth trying if you have joint or muscle strains or bruises. Apply the cream directly to the area, and it is absorbed through your skin. Ask your doctor or pharmacist about diclofenac, a prescription NSAID that also comes as a gel (brand name Voltaren), as drops (Pennsaid), and as a patch (Flector).

You can also buy over-the-counter creams, such as Icy Hot, which contain aspirin. Topical treatments might be an especially good option if you have trouble swallowing pills. But diclofenac isn't cheap: a month's supply can cost between $168 and $370, or even more, depending on how much and how often you use it. And the prescription medication is not available in generic form. The OTC aspirin creams from the drugstore are a lot less expensive, so you might want to start with one of those.

Also be aware that using topical treatments might not reduce your risk of the ulcers and gastrointestinal bleeding that are sometimes caused by taking NSAID medications. Another caution: few studies have been done of the rub-in medications, and so far it's not clear that they're safer than pills. So if pills are working for you, it might be a good idea to stick with those.

Should you take an aspirin a day?

Taking low-dose aspirin (81 milligrams or baby aspirin) can help ward off stroke for some women 65 and older and heart attack for men 45 to 79. But if you take aspirin, skip ibuprofen for pain relief. The combo might lead to stomach bleeding and ulcers.

These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

If you think you have experienced an adverse event with this drug or any drug, especially if it is of a serious nature, it is important to 1) tell your doctor immediately and 2) report the event to the Food and Drug Administration via the FDA's MedWatch Web site at www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm or by calling 1-800-FDA-1088.
   

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