OTC Pain Relievers

Pain isn’t always chronic. To help manage acute pain episodes, there are a number of effective over-the-counter pain relievers. Here’s how to select the one that’s right for you.

Let’s say you’ve been suffering from significant joint pain for several days. What’s your first instinct in addressing it? Is it to schedule an appointment with a pain doctor, or is it to ask your physician for prescription pain medicine? If either of these scenarios popped into your head, you might be jumping the gun, says Kamal S. Ajam, MD, clinical assistant professor of anesthesiology at Wake Forest Baptist Health.

“Over-the-counter (OTC) remedies should be the first line of treatment for most pain complaints, acute or chronic,” he says. “Assuming the pain isn’t unusual, severe or accompanied by other symptoms, like vomiting or bleeding, an analgesic from your local drugstore may be your best, most affordable option. If this method doesn’t effectively address your pain, then you should see a physician.”

OTC Options

When it comes to OTC options, there are several categories:

•  Aspirin NSAIDs

•  Non-aspirin NSAIDs

•  Acetaminophen

•  Topical treatments

An NSAID is a nonsteroidal anti-inflammatory drug. Aspirin is a well-known NSAID, but non-aspirin varieties such as ibuprofen (Advil, Motrin) and naproxen (Aleve) are also popular. Acetaminophen (Tylenol) is not classified as an NSAID. NSAIDs and acetaminophen may be found in over-the-counter cough medicines and in some pain powders. Be sure to watch your total daily consumption of any of these medications. Exceeding the recommended doses can be fatal; however, if taken in proper doses, acetaminophen and NSAIDs can be taken at the same time.

The most common OTC topical treatments contain hydrocortisone, capsaicin, menthol or camphor—and they usually come in cream, ointment or patch form.

To choose the best OTC pain reliever for you, consider not only what type of pain you want to treat, but also what other health conditions you have. NSAIDs, while effective, can increase your risk of internal bleeding. If you have any of the following risk factors, you may want to steer clear of them—or at least check with your doctor first:

•  A history of ulcers or bleeding in the stomach or intestines

•  Chronic stomach pain or discomfort

•  A history of stroke or kidney, liver or heart disease

•  High blood pressure

•  Pregnancy

•  Previous allergic reaction to aspirin or any other NSAID

•  Advanced age

•  Heavy drinking

•  Anemia

•  Easy bruising

•  Already taking high does of NSAIDs for a long period

•  Taking a blood thinner

•  Taking water pills

•  Taking certain medications for arthritis or diabetes

 If you’re unable to take NSAIDs for any of the above reasons, acetaminophen may be a good option for you. Dr. Ajam says it’s the top OTC medication he recommends to his patients. “I almost always suggest Tylenol first—especially for arthritis-related pain,” he says. “If it’s taken at dosages below 3,000 milligrams (in a 24-hour time period), it’s almost always without side effects.”

Tylenol is certainly the best option for Kevin White.^* He has rheumatoid arthritis (RA), which sometimes causes painful flare-ups. Because he has high blood pressure and is on an anti-rheumatic drug (which can interact with NSAIDs), his rheumatologist suggested he take Tylenol.

“For at least 20 years, it’s been my go-to for RA flare-ups,” White says. “Often, I need to double my dose, but as much as I’ve used it, I’ve never experienced side effects from it. I feel like it’s the safest drug in my medicine cabinet

Targeting Pain with OTC Topical Pain Relievers

The other OTC treatment White uses regularly is a topical capsaicin cream. “I find it lets me target certain areas, like my shoulders,” he says.

Capsaicin is a compound derived from chili peppers. As a result, it can cause a great deal of irritation and discomfort if applied incorrectly. Dr. Ajam knows this firsthand. “Growing up in Indonesia, I strained my quads playing soccer,” he remembers. “There, we didn’t have the pain management and sports medicine options we have in the United States, so I visited a massage therapist who recommended I try a capsaicin patch I didn’t know I only needed a small amount, so I ended up applying the whole patch to my leg. After wearing the patch for just a few minutes, it felt like I had been burned.”

Topical medications are best used for mild to moderate muscle and joint pain. These treatments should not be used for burning pain, such as the pain associated with shingles, and they should never be used on the face.

Pain Conditions That Respond Well to OTCs

Arthritis, Back Pain & Injuries

Many types of arthritis—as well as general joint and low back pain—can be treated with an OTC pain medicine like Tylenol. In fact, studies have shown that people with osteoarthritis experience less pain and feel better overall when taking acetaminophen.

Other types of pain also respond well to NSAIDs. Physicians and pharmacists recommend NSAIDs over acetaminophen for the treatment of sprains and strains, due to the anti-inflammatory properties the drugs possess. Tylenol is a good backup for people who are at high risk for NSAID-related complications or who have been advised by their doctors not to take NSAIDs.

“It’s always a good idea to check with your pharmacist first,” says Jim Cohn of Walgreens Pharmacy Media Relations. “If someone is taking other medications, NSAIDs and other products may not be safe.”

Migraine & Headaches

Migraine and headache pain sometimes respond well to NSAIDs, but be careful about using this category of drugs to treat headaches all the time, says Dr. Ajam. Taken too frequently, both NSAIDs and Tylenol can lead to medication-overuse headaches, as can caffeine-containing OTC drugs like Excedrin.

Post-Operative & Cancer Pain

If you’re experiencing post-operative pain or cancer pain, seek guidance from your surgeon, oncologist, or a pain management specialist first. If the pain is related to a rheumatologic condition, make sure you are seeing a rheumatologist to address the root causes of your pain. If, like White, you’re already taking biologic or anti-rheumatic drugs, you may opt for an OTC painkiller to address flare-ups.

OTC Treatments, Lifestyle & Pain Management

Don’t be too quick to overlook Tylenol or NSAIDs as components of your pain management regimen. They’re important pain treatments that can reduce the need for narcotics, says Dr. Ajam.

“The hope is that the OTC will reduce the amount of prescription painkillers a person takes—or, in some cases, reduce the need for the prescription altogether,” he says. “However, if the narcotics are still needed, an OTC like Tylenol can work synergistically with the prescription painkiller.”

Dr. Ajam points out that OTC options can be particularly effective when combined with lifestyle changes, such as weight loss. “It’s common for people who are overweight to experience knee pain and request a prescription for pain medication,” he says. “Generally, what they need to do is take Tylenol and make the necessary lifestyle changes to get to a healthier weight. Overall, being more fit will help them feel better, reduce their pain and allow them to stop taking expensive or potentially addictive medication.”

A Word of Caution!

In addition to talking to your doctor or pharmacist about potential risk factors or medication interactions related to OTC treatments, be cautious about how much OTC medication you take. For instance, you might be taking appropriate doses of Tylenol, but if you also start taking a cold medicine with Tylenol, you could end up exceeding your recommended dosage without knowing it.

“OTCs are generally safe, but no medication is completely benign if it’s taken too long or at significant doses without the supervision of a doctor,” says Dr. Ajam. “There is a limit on how much you should self-treat. If your pain persists, call your doctor.” {PP}