Take the pain of choosing a painkiller

Whether it’s due to back problems, sports injury, accident or otherwise, approximately 100 million Americans live with chronic pain. That’s almost twice as many people with diabetes, heart disease or cancer combined. Pain relief usually starts at the local pharmacy, where options range from standard (Tylenol) to weird looking (a device that shocks your skin). What will do the most good and the least harm?

According to Joseph Ma, PharmD, associate professor of clinical pharmacy at the Skaggs School of Pharmacy and Pharmaceutical Sciences at UC San Diego, there are a few questions to ask yourself before choosing an over-the-counter pain relief method or decide when it’s time to see a doctor:

1. 
   Where is the pain?
   If your pain only affects a small part of your body, a topical pain cream, such as Bengay, might help. One advantage of topical creams is that they are localized – you don’t have to take a pill that affects your whole body and can cause unwanted side effects, such as stomach upset. But if your whole back hurts, a messy cream probably isn’t realistic. So in this case, especially for short-term relief, Ma said, you’ll probably want to take acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug, or NSAID. NSAIDs include aspirin (eg, Bayer, Excedrin), ibuprofen (eg, Advil, Motrin), and naproxen (eg, Aleve).
2. 
   What is the cause?
   NSAIDs generally work well when the pain is caused by inflammation, such as when your muscles are sore after running your first 5k. Acetaminophen relieves pain, but does not reduce inflammation.
3. 
   How severe is the pain?
   
   If the pain is bothersome, but not terrible, and you’re looking for a non-drug option, icing or heating might do the trick. Ma said distraction methods might also be worth trying for mild pain. Although there isn’t much hard evidence of their effectiveness, some of his patients anecdotally report improvement after doing yoga and meditation, or after using transcutaneous electrical nerve stimulation (TENS). With TENS, you attach a small, battery-powered machine to the painful site or pressure point such as your wrist. The electrodes send small electric shocks through your skin. Some experts theorize that TENS may work for some people because it blocks normal pain signals or produces endorphins that block the perception of pain. Ma said electric shocks can just keep you from thinking about your mild pain all the time.
4. 
   How long have you been in pain? Is it getting worse?
   NSAIDs work for most people, at least in the short term, Ma said. So if you’ve been taking them and maybe using an ice pack or heating pad consistently for a week and you don’t see any improvement, it’s time to see a doctor. Most over-the-counter pain relievers can relieve pain as a symptom, but they may not address the underlying cause. You will need to see a doctor to find the true source of your pain.
5. 
   What underlying health issues do you have?
   Acetaminophen can damage your liver, especially in high doses or in combination with alcohol. NSAIDs can upset your stomach, so it’s best to take them with food. NSAIDs can also be hard on the kidneys. Ma said older people and anyone with kidney problems should be wary of taking too many NSAIDs and may want to talk to their doctor as soon as possible. The same is true for people taking blood thinners, as some NSAIDs can affect platelet function. Ma also warned that acetaminophen and NSAIDs are found in many products that aren’t just for pain relief, so people may be taking more than they realize. For example, acetaminophen is commonly found in sleeping pills and cough syrups.
6. 
   What has worked for you in the past?
   Take a moment to reflect on what has worked in the past and start there, Ma said. Shiny and new isn’t necessarily better. If ibuprofen helped you after you had your wisdom teeth removed a few years ago, chances are it will help you again.
   

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