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Which painkiller is right for you?

By Melissa J. Luther, Contributing writer
Published On: May 25 2011 09:47:37 AM CDT

Occasional minor aches and pains are a normal part of life, and over-the-counter pain relievers are usually sufficient treatment.

Aspirin, classified as a nonsteroidal anti-inflammatory drug, was once the pain reliever of choice, but concerns about bleeding risks prompted many people to switch to acetaminophen, usually sold as Tylenol.

Acetaminophen, which is classified as an analgesic and fever reducer, cannot treat inflammation, however. It also causes liver damage in high doses.

Newer NSAIDs, such as ibuprofen (sold as Motrin and Advil), naproxen sodium (Aleve) and ketoprofen (Actron), treat inflammation without the bleeding risk, but may increase the risk of heart attack and stroke.

With so many choices, and attendant risks, how do you choose?

What Treats What?

All OTC pain medications can successfully treat minor muscle aches, headaches and menstrual pain. They typically do this by preventing the body from producing pain-causing chemicals. They reduce fever by resetting the body's thermostat.

The NSAIDs also reduce inflammation, making them useful for treating chronic inflammatory diseases such as arthritis, gout and rheumatic fever. Acetaminophen has no effect on inflammation, so it can only reduce the pain, not the underlying swelling.

Aspirin is useful for more than just pain relief. Long-term aspirin therapy helps to prevent heart attacks and stroke. It does this by preventing blood platelets from sticking together, thus preventing clot formation.

Other NSAIDs also prevent clot formation, but only for a few hours. Aspirin inhibits clotting for up to 7 days.

Ibuprofen also inhibits uterine contractions, making it especially useful for menstrual cramps. It is also sometimes used to stop early labor, but only under a doctor's supervision.

Use Caution With Pain Killers

All drugs have potential side effects. Most are rare, but some people are uniquely sensitive to certain drugs. Adverse reactions are difficult to predict in advance, but certain groups of people should exercise caution when using some pain relievers.

Children and teenagers with flu symptoms or chicken pox should never take aspirin. Aspirin increases the risk of Reye's syndrome, a rare, potentially fatal disease that causes brain inflammation and liver damage.

People with asthma, bleeding disorders or nasal polyps should talk to a doctor before using any NSAID.

Women who are more than 24 weeks pregnant or breast-feeding should not use aspirin or any NSAID. Aspirin can affect development of the unborn child. It also passes into breast milk and can build up in an infant's body. Acetaminophen is a safe alternative that carries no known risk to either the unborn child or nursing infant, but it should still be used only when absolutely necessary.

People over age 60 are more likely to experience side effects from NSAIDs but not from acetaminophen.

Aspirin greatly increases the risk of bleeding in patients who are taking blood thinners. Other NSAIDs and acetaminophen may also increase the anticoagulant effects of blood thinners, but to a lesser degree.Certain supplements increase bleeding risk from NSAIDs. These include garlic, ginseng, ginko and vitamin E supplements.Alcohol increases the risk of bleeding from NSAID use and the risk of liver damage from acetaminophen.Diabetics may get false glucose results when using acetaminophen.

Ibuprofen, naproxen sodium and ketoprofen increase the risks for high blood pressure, heart attack and stroke, especially with long-term use. Anyone with risk factors for these conditions, including being overweight, diabetic, a smoker, a male over 40, a postmenopausal female, or having high cholesterol, should talk with a doctor before using these drugs to treat chronic conditions.

Long-term use of acetaminophen may cause anemia, especially in people with a G6PD deficiency (a hereditary condition that causes red blood cells to be destroyed). It's best to limit use to 10 days.

Combination Drugs

Always read the label before taking any drug. It will list ingredients and common side effects.

Acetaminophen is often combined with other drugs. Excedrin, for example, is acetaminophen, aspirin and caffeine. Many cough and cold medications are also combinations of acetaminophen and other drugs. The risk of overdose is high if you do not read the labels.

NSAIDS are generally safe to treat occasional acute pain or inflammation, and acetaminophen is generally safe for pain, as long as you follow directions. Use the one that works best for you. For chronic conditions, consult with a doctor to find the best treatment for you.

Note: Information based largely on


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