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 into 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. 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, except for 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.
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 several 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 the 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 200mg of Ibuprofen with 500 mg of acetaminophen had an NNT of
1.6 which means it worked almost as well as the combination of 400mg of Ibuprofen
with 1000mg 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 200mg and 400mg doses of fast-acting formulations of
ibuprofen alone, which are designed to be quickly absorbed into the
bloodstream, and a combination of 200mg of ibuprofen with 100mg 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 200mg of Ibuprofen and 500mg of acetaminophen may
be best for temporary pain relief.