OTC Pain Relievers: Which Ones are Right for You?

Years ago, if you had a headache or your arthritis was acting up, you went to the drugstore for a bottle of aspirin. Today, relief from everyday aches and pains or a specific disease or condition means choosing from more than 150 over-the-counter (OTC) preparations.

One product promises "8-hour" relief, another "no stomach upset," and yet another "fast" pain relief. Although the packaging and promises are different, practically all nonprescription pain relievers contain one of these chemicals: aspirin, acetaminophen, ibuprofen, naproxen sodium or ketoprofen.

For pain relief, the differences among products are usually more subtle than significant. But using OTC pain relievers safely is not as simple as you may think.

Matching the pill to the pain

The ingredients in OTC pain relievers are analgesics — from the Greek "an," meaning without, and "algos," meaning pain. All relieve minor pain associated with headache, arthritis, colds, toothache, muscle ache, backache and menstrual cramps. They also reduce fever.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as aspirin, ibuprofen (Advil, Motrin, others) and many others -- reduce inflammation as well as relieve pain. If you have rheumatoid arthritis, for instance, suppressing inflammation is particularly important because of the damage inflammation can cause. Controlling inflammation can also reduce your pain.

Compared with the group of anti-inflammatory medications called corticosteroids, such as prednisone (Deltasone, Orasone, others) and cortisone (Cortone Acetate, others), long-term use of NSAIDs doesn't cause serious side effects such as thinning of your skin, osteoporosis or cataracts. However, NSAIDs may have other side effects, such as headache, dizziness, drowsiness, gastrointestinal upset and bleeding, high blood pressure and fluid retention.

Acetaminophen doesn't relieve inflammation. But because it's relatively free of side effects, it's a good alternative if taking NSAIDs presents special risks.

All regular-strength doses of OTC pain relievers provide comparable relief for everyday pain such as headache or sore and stiff joints and muscles. For menstrual pain, NSAIDs such as ibuprofen and naproxen sodium may offer better relief.

Despite the similarities in effectiveness, you face a dizzying array of products. Does adding an ingredient, increasing the strength or changing the shape mean better relief?

Typically, it just means paying more. To make a smart choice, compare prices per tablet for regular-strength aspirin in the generic form with products that have added ingredients, such as an antacid.

Here's a guide for sorting through enticing descriptions and innovative forms of drug delivery:

Buffered. A buffered analgesic contains an antacid to reduce acidity. Whether or not these products actually protect your stomach is controversial.

Enteric-coated. A special coating allows these pills to pass through your stomach intact and dissolve in your small intestine. This helps reduce stomach irritation. Consider an enteric-coated product if you need daily relief for chronic pain. Because the coating delays absorption, it's not the best choice for quick relief from occasional joint pain or the occasional headache.

Timed-release. Also called extended-release and sustained-release, these products dissolve slowly. This action prolongs relief by maintaining a more constant level of analgesic in your blood. Choose timed-release when you need lasting rather than immediate relief.

Extra-strength. A single dose of these preparations contains more pain-relieving medicine than regular-strength products -- typically 500 milligrams versus 325 milligrams for aspirin or acetaminophen. They're more convenient when you need more than one regular-strength dose to improve your symptoms.

Combination formulas. Some products are paired with caffeine or an antihistamine to boost their effectiveness. Caffeine added to aspirin or acetaminophen, for instance, improves pain relief in some types of headaches. Less data are available on caffeine's effect on ibuprofen.

Tablet, caplet, gelcap, gum or liquid. These different forms try to provide the easiest method for getting the medicine down. If you have trouble swallowing a round tablet or oval caplet, a smooth gelcap might work better. Take these forms -- and any medication -- with at least 4 to 8 ounces of liquid to be sure they don't get lodged in your esophagus and cause irritation or a chemical burn. Other options include taking aspirin as an effervescing pain reliever plus antacid (Alka Seltzer) or chewing aspirin as a gum (Aspergum).

Generic. Generic pain relievers almost always cost less than brand name drugs, and they're usually just as effective.

For safe and effective use:

Know your special risks. In general, don't take NSAIDs if you take a blood thinner or if you have kidney disease, ulcers, a bleeding disorder or an allergy to aspirin. Don't give aspirin to children. Aspirin has been linked to Reye's syndrome, a potentially fatal swelling of brain tissue in children and teenagers.

Avoid drug interactions. If you take other OTC or prescription medications, talk with your doctor or pharmacist about which pain reliever is best.

Don't exceed the recommended dosage. Rather than overload your system at one time, follow product instructions for proper dosage and timing. Never exceed the recommended dosage unless your doctor advises it.

Avoid alcohol. Mixing alcohol with NSAIDs such as aspirin, ibuprofen or naproxen sodium increases your chance of stomach upset and bleeding. When combined with higher-than-recommended doses of acetaminophen, alcohol increases the risk of serious damage to your liver.

Take with milk and food. These help minimize stomach upset associated with NSAIDs.

Don't take longer than necessary. Periodically re-evaluate your need for pain relievers.