There are almost as many brands of painkillers as there are types of pain. The question is, which painkiller is the right choice for your particular situation, whether it's an ache, a twinge or any other form of discomfort.
But the terrain of painkillers is not as complicated as it might seem when you first scan crowded pharmacy shelves.
There are two major categories of pain relievers, explains Alexa Mieses Malchuk, MD, a family physician at the University of North Carolina in Chapel Hill. The first is nonsteroidal anti-inflammatory medications (NSAIDs), which include ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin. The second category is acetaminophen (Tylenol) — this pain reliever does not address inflammation.
Either an NSAID or acetaminophen (or, at times, even both) can be effective for everyday pain and fever, Dr. Mieses Malchuk says. But only NSAIDs can help reduce inflammation (swelling). Mind you, most types of pain such as muscle aches, headaches and period cramps do involve some amount of inflammation, she adds.
Dosing and side effects also differ for these two categories of meds.
Here are some common types of pain and how you can treat them with over-the-counter painkillers.
Starting with Tylenol can be helpful, since it generally has the lowest risk of harmful side effects, per Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital in New York City. (More on side effects below.) But if you generally find other medications more helpful at easing your headache symptoms, opt for what you typically find effective.
Be on the lookout for rebound headaches, which can happen if you take too many painkillers, Dr. Mieses Malchuk says. Don't take painkillers more than a couple of days a week, per the Mayo Clinic. And always follow the directions on the label.
Before treating a headache, make sure that it’s not a symptom of something more serious, like a stroke or a brain aneurysm. These headaches tend to be severe, start suddenly and get worse with time, according to the National Library of Medicine (NLM). Changes in vision, numbness, tingling or weakness can be red flags, Dr. Mieses Malchuk says.
If you have symptoms like this, go to an emergency room or contact your health care provider right away.
NSAIDs can be helpful to reduce the discomfort of period cramps, Dr. Mieses Malchuk says. In fact, if you have a history of really bad cramps, you can start taking painkillers one to two days before your period starts to help prevent or lower the level of pain, she adds.
The most common causes of muscle aches include injury or trauma, tension and stress and exercise, per the NLM. And many of these involve inflammation. That makes NSAIDs like ibuprofen or naproxen an obvious choice, as long as you don't have any risk factors and you don't take too much.
Aspirin is not used for pain much anymore, Dr. Mieses Malchuk says. Doctors do prescribe low-dose aspirin to prevent a second heart attack or stroke.
Some 80 percent of us will need medical help at some point in our lives for back pain, according to Harvard Health Publishing. And there are likely more people who don't seek medical help.
Back pain can have many causes, such as sitting too much, bad posture, injuries or arthritis. Taking an NSAID can be helpful for easing minor or temporary back pain. Just note that these meds are intended for short-term use, per the Cleveland Clinic. Always follow the dosage instructions on the package. Reach out to your doctor if the pain persists or if you have a chronic condition, such as arthritis.
Some people forego medication entirely for back pain, instead looking to physical therapy, acupuncture or even meditation for relief, according to Johns Hopkins Medicine.
Infections (both viral and bacterial), allergies and even postnasal drip can all cause sore throats. If you think you have an infection, check with your doctor. Bacterial infections can be treated with antibiotics. Other types of sore throats can be eased by either acetaminophen or an NSAID, Dr. Mieses Malchuk says.
Many cold and flu medicines also contain acetaminophen and other painkillers.
If you’re taking any combination products, make sure you check the label so you don’t go over the daily recommended dosage which, for acetaminophen, is typically 3,000 milligrams a day, according to Harvard Health Publishing.
Arthritis is one of the most common causes of joint pain, especially as we get older. Osteoarthritis, which is more common with age and with "wear and tear," is the most common type, according to the Arthritis Foundation, and affects millions of Americans.
Inflammation is one of the main features of arthritis, making NSAIDs a go-to medication for people who have the condition. But speak to your health care provider if you're using them frequently for pain management, since NSAIDs should only be used for a few days at a time.
Both acetaminophen and ibuprofen can treat fevers. Dosing for each is different: Try taking acetaminophen every 4 to 6 hours, and ibuprofen every 6 to 8 hours, per the NLM.
You shouldn't give ibuprofen to children who are younger than six months. Aspirin can also help treat fever, but never give it to children, since it's been linked with Reye's syndrome, which can cause liver and brain swelling, per the Mayo Clinic.
How to Choose the Best Painkiller for You
Personal preference plays a role in choosing a pain reliever, regardless of what kind of pain, Dr. Mieses Malchuk says. But so do your personal risk factors. Every drug has a downside and over-the-counter pain relievers are no exception.
Acetaminophen has fewer side effects, but they can be serious. The main potential side effect is liver damage, especially if you drink three or more drinks daily, per the U.S. Food and Drug Administration.
"Regular use [of acetaminophen] does not really have much toxicity at all," Dr. Horovitz says, but make sure not to exceed the dosage instructions.
NSAIDs are associated with kidney damage if you take them for long periods of time.
"If you have any level of kidney dysfunction or kidney disease, you have to be really, really careful and talk with your doctor before taking an NSAID," Dr. Mieses Malchuk says. "In some cases if you have kidney disease, you can't take NSAIDs at all."
NSAIDs can cause heartburn, stomach pain, diarrhea and other GI-related side effects, per the Cleveland Clinic. It's also possible that these meds will cause you to bruise easily, according to Harvard Health Publishing.
NSAIDs other than aspirin could increase the chance of heart attacks and strokes, per a 2015 warning issued from the U.S. Food and Drug Administration. You also shouldn't take NSAIDs when you're pregnant, Dr. Mieses Malchuk says.
Generally speaking, go for acetaminophen for most mild pain, Dr. Horovitz advises. "It doesn't have the potential toxicity that NSAIDs do."
But if you're dealing with pain along with inflammation — which period cramps or muscle aches, for instance — an NSAID is likely to be most effective.
Both acetaminophen and NSAIDs can sometimes interact with certain other medications. If you take prescription medications, check with your doctor if there is any type of pain reliever you should avoid.
When to Call a Doctor
If you've injured yourself playing sports, in a car accident or after a fall and you have pain, see your doctor, Dr. Mieses Malchuk advises. Any new, unusual or severe pain or pain that lasts a long time also warrants talking to a health care provider, she adds.
Is This an Emergency?
- Harvard Health Publishing: “Which painkiller is safest for you?”
- Stanford Health Care: “Types of Headache”
- National Library of Medicine: “Headaches - danger signs”
- Mayo Clinic: “Medication overuse headaches”
- National Library of Medicine: “Muscle Pain”
- Harvard Health Publishing: “The best meds for back pain”
- Johns Hopkins Medicine: “7 Ways to Treat Chronic Back Pain Without Surgery”
- Arthritis Foundation: “Osteoarthritis”
- National Library of Medicine: “Over-the-counter medicines”
- Mayo Clinic: “Sore throat”
- American Academy of Family Physicians: “Chronic Pain Medicines”
- Food and Drug Administration: “FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes”
- Cleveland Clinic: "Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)"
- Harvard Health Publishing: "Are you taking too much anti-inflammatory medication?"
- U.S. Food and Drug Administration: "Acetaminophen: Avoiding Liver Injury"