Most households have a stash of painkillers tucked away for surprise headaches or stubborn cramps. However, some may not realize that all painkillers are not created equal, and they don’t all treat the same kind of pain.
Over-the-counter (OTC) pain relievers fall into two main categories, according to MedLine Plus. The first is NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen. These medications reduce both pain and inflammation, but can irritate the stomach if not taken with food, according to Dr. Jessica Oswald, an anesthesiologist and pain management specialist at UC San Diego Health.
The second category is acetaminophen, which also helps with pain and fever, but does not reduce inflammation. Dr. Min “Frank” Wu, a physician at AdventHealth in Littleton, Colorado, explained the differing mechanisms of these drugs in the body. NSAIDs inhibit cyclooxygenase enzymes (COX-1 and COX-2) throughout the body, which means they inhibit the production of biological mediators that cause inflammation and blood clotting.
Acetaminophen, on the other hand, works by inhibiting COX enzymes and modulating the endocannabinoid system in the central nervous system to exert its effects. While acetaminophen is effective for migraines, it has limited effectiveness for arthritic pain, according to Wu.
Combining acetaminophen with NSAIDs has been shown to be more effective than either medication alone, noted Wu, who advocates for a multimodal approach to pain relief. This strategy, he said, allows for targeting pain in different ways, potentially improving outcomes.
Despite their benefits, both types of medications carry risks. NSAIDs can cause gastrointestinal issues, ulcers, and bleeding, particularly with higher doses. They are also associated with kidney impairment, heart disease, and, in rare cases, liver damage, noted Wu. Acetaminophen, while generally safer, carries a risk of liver injury and serious skin reactions, according to the FDA.
Oswald recommended that individuals with certain health conditions, such as kidney problems, heart issues, or stomach ulcers, should consult a doctor before using NSAIDs. Acetaminophen is generally safer, as long as it is used within the recommended daily dose of 3,000 milligrams.
Ultimately, both NSAIDs and acetaminophen have their place in pain management, and having access to both types of OTC medications allows for more effective pain relief. However, the article advises consulting a healthcare professional if pain persists or worsens, to explore other treatment options.