December 9, 2022

Know your pain medication options and how to choose between them

When you have stabbing pain that won’t go away, over-the-counter (OTC) pain relievers can offer quick relief. After rummaging through your medicine cabinet, you may have several options to choose from. Ibuprofen, acetaminophen, aspirin and more – what’s the difference? Although many over-the-counter pain products can solve similar problems, not all are the same.

Yasmin Nejad, PharmD, of Samaritan Pharmacy – Corvallis, described the differences between four common painkillers and when you can use one or the other.


Acetaminophen, found in Tylenol and other over-the-counter medications, is thought to work by blocking pathways in the brain so you don’t feel as much pain, and it can also inhibit pain systems in your brain. other parts of the body. Acetaminophen is effective in treating a wide range of aches and pains as well as reducing fever. It has a minimal side effect profile when taken correctly and safely, making it a great place to start if you’re experiencing mild pain like a headache.

“Acetaminophen can be a good starting point for people with mild to moderate pain,” Nejad said.

This drug is metabolized by your liver, so do not take it with alcohol or if you have liver problems. It can also be dangerous to take it with a common blood-thinning medicine called warfarin and can lead to an increased risk of bleeding in high doses for a long time.


Ibuprofen can be found under the brand names Motrin or Advil. This is a type of painkiller called a nonsteroidal anti-inflammatory drug (NSAID), which works by inhibiting processes in the body that can cause pain and inflammatory responses, resulting in pain relief. This makes it useful for conditions like an earache or a twisted ankle, where swelling contributes to discomfort, but it shouldn’t be taken to treat inflammation unless directed by a healthcare provider. health. Ibuprofen can also be used to help reduce fever.

This drug is metabolized by the liver and affects the kidneys. People with liver problems should therefore exercise caution. People who do not have full kidney function or are taking other medications that affect the kidneys may not be able to take ibuprofen. Ibuprofen can also increase your risk of bleeding, which can be a problem for people with bleeding disorders or who are already taking a blood thinner like warfarin. Ibuprofen can also aggravate certain heart conditions and increase blood pressure.

Side effects of ibuprofen can include nausea, heartburn, or gastrointestinal upset like diarrhea or constipation. Nejad recommended taking the drug with food if you notice any of these uncomfortable side effects.

“There are instances where the effects of an NSAID are helpful, so if acetaminophen isn’t helping your pain, ibuprofen might be the next step if you’re able to take it,” Nejad said.


Aspirin is widely available, but Bayer is one of the most common brands. It is another form of NSAID and works in the body similar to ibuprofen to control pain.

Although all NSAIDs have some level of blood thinning ability, aspirin is particularly effective. In fact, aspirin is most often used in low doses as a daily defense against heart attacks or strokes. Nejad reported that while aspirin can help relieve minor aches, headaches, or fever, ibuprofen is generally preferred because it is considered better tolerated and more effective in reducing pain.


Naproxen, found in Aleve, is another type of NSAID. It can help relieve pain from sources such as arthritis, menstrual pain, or headaches. Nejad noted that naproxen has a similar side effect profile to ibuprofen and can be considered if ibuprofen isn’t effective. It also has a longer duration of pain relief compared to ibuprofen.

Beware of adding acetaminophen

When you’re not feeling well, check the label of cough-and-cold medicine, sleeping pills, or combination pain relievers. Acetaminophen is often added to these products, so if you take multiple medications containing acetaminophen, you may be taking too much.

“Acetaminophen is generally well tolerated at regular doses, but the window of safety becomes smaller as the amount taken increases,” Nejad said. “At toxic levels, acetaminophen can do a lot of damage, so it’s very important to be careful about how much you take per day.”

The current maximum dose of acetaminophen is 3,250 mg in a 24-hour period for most people with healthy livers, but some experts recommend going up to 3,000 mg in 24 hours.

Pain management and long-term use

Over-the-counter pain relievers can be helpful for occasional pain, but don’t rely on them for long-term relief without consulting your primary care provider first.

“NSAIDs like ibuprofen and naproxen can irritate the lining of the stomach and small intestine, and can cause small sores called peptic ulcers,” Nejad said. “If you have persistent pain, such as daily arthritis pain or an old injury, long-term use of NSAIDs may not be safe unless under the direction of a physician.”

Taking ibuprofen for a short time, such as for an arthritis flare-up or a headache, is usually not a problem, she noted.

Although acetaminophen is potentially better tolerated than NSAIDs, taking it frequently in high doses can also be harmful and lead to liver damage.

If you still experience pain while taking the maximum daily dose of acetaminophen or ibuprofen, it’s usually safe to alternate between the two for a day or two, Nejad said.

“Take a regular dose of acetaminophen, then four hours later a regular dose of ibuprofen,” she said. “Because they work differently in the body, these two medications can work together to safely manage your pain for a short time.”

Just make sure you don’t exceed the daily maximum of either medication and be sure to note if your pain improves.

“If you are seeking an over-the-counter pain reliever most days for 10 days or longer, please see your primary care provider to discuss the cause of pain and long-term treatment goals,” Nejad said. “There are also many over-the-counter products that can be applied to the skin for local pain relief. Non-opioid options are also available with a prescription from your provider that can be used if indicated.

Acetaminophen Ibuprofen Aspirin Naproxen
Common products Tylenol. Motrin & Advil. Bayer. Come on.
Common uses
  • Arthritis.
  • Antipyretic.
  • Headache.
  • Minor aches and pains.
  • Cold & flu symptoms.
  • Arthritis.
  • Antipyretic.
  • Headache.
  • Muscle pain and strains.
  • Menstrual cramps.
  • Earache.
  • Toothache.
  • In low doses to prevent heart attacks or strokes as recommended by a health care provider.
  • Minor aches and pains
  • Arthritis.
  • Antipyretic.
  • Headache.
  • Muscle pain and strains.
  • Menstrual cramps.
Maximum daily dose 3250mg/24 hours. 1200mg/24 hours. 3900mg/24 hours. 600mg/24 hours.
Do not use*
  • Liver disorder.
  • Take warfarin.
  • Kidney disorder.
  • Aspirin allergy.
  • Take blood thinners.
  • Kidney disorder.
  • Take blood thinners.
  • Bleeding disorder.
  • Kidney disorder.
  • Take blood thinners or aspirin every day.

Fever and pain relief for children

Talk to your child’s pediatrician before giving painkillers to children under 6 months old. For children over 6 months, always use a pain reliever formulated for children and select the correct dose based on their weight, not their age. Both acetaminophen and ibuprofen are effective in helping to lower fever, but a report published by the American Academy of Pediatrics suggested that ibuprofen is often preferred as it may be able to keep the fever down for longer.

Never give aspirin to children or adolescents under 18, due to the risk of a rare side effect called Reyes syndrome which can affect the brain and liver. Naproxen should not be given to children under 12 years old.

How to choose the right painkiller

Nejad recommended always starting with the lowest dose that gives you the relief you need, no matter which product you choose.

“For most people, acetaminophen has fewer side effects and is a good starting point for general pain relief. However, there are cases where ibuprofen is more effective,” Nejad said. “These are usually my first two recommendations, as they manage mild to moderate pain well and are readily available.”

Learn more about chronic pain management in our health library.

Learn more about improving back pain.