Finding Pain Relief Over the Counter

Finding simple relief for that throbbing headache or aching back has never been so difficult. Would you call the headache a migraine? Would it best be addressed by a "gelcap," or is it more of a tablet sort of pain? And don't they say that liquids work faster than pills?

Drug stores, supermarkets and mass merchandisers like Target and Kmart sold more than $2 billion worth of over-the-counter pain medicine in the past year, according to the consumer goods tracker Information Resources Inc. The myriad of choices in the drug store aisle is enough to make that headache worse. It's a maze of fancy labels, diverse pill forms and claims of body-part specific relief.

But in reality, the choices are much fewer then they appear. Medical experts say there is little variance between the actual pain-relieving medicine in over-the-counter drug brands and scant evidence to document that one relieves pain more effectively than the others. In fact, most pain products are very similar medications packaged and mass-marketed to appeal to different consumer needs.

So how should consumers choose? The truth is, it might not matter. Just like selecting based on your favorite label, experts say, it's all about personal preference.

"There are only so many over-the-counter analgesics allowed for use by the FDA [Food and Drug Administration], so it's going to be mostly the same drugs," said Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute. "There is truly evidence that some people respond to some drugs but not to others."

Aspirin First Widely Used

Aspirin, the original universal pain reliever, was discovered late in the late 1800s as an extract of willow bark. It was found to be an effective pain reliever and fever reducer and was first sold by Bayer in 1899. By the early 20th century, aspirin was being mass-marketed over the counter, and it is still a popular drug today.

But some people have trouble digesting aspirin, particularly children, and in extreme cases it can cause internal bleeding. The negative side effects were a catalyst for continued research as scientists sought safe, effective pain medicine with fewer problems.

"The impetus has been to find this 'magic drug' that has the same pain-relieving power but doesn't have any adverse side effects. But that hasn't happened yet," said June Dahl, professor of pharmacology at the University of Wisconsin-Madison Medical School.

The first mass-marketed, aspirin-free pain reliever, acetaminophen, most widely known as Tylenol, was hit the over-the-counter market in 1955. In 1984, ibuprofen, the active drug in products like Advil and Motrin, was approved by the FDA, followed 10 years later by naproxen-based Aleve.

Today, the top four brand-name sellers -- Advil (ibuprofen), Tylenol (acetaminophen), Aleve (naproxen) and Bayer (aspirin) -- contain those four ingredients, and most other brands contain one or some combination of the four. IRI estimated that Advil tablets were the biggest seller among the brand names during the past 12 months, with nearly $280 million in total sales.

All four have varying degrees of small side effects -- including gastrointestinal, kidney and liver problems -- which can become dangerous if the products are taken at more than the advised dosage. And because people react to each ingredient differently, pain researchers are hesitant to anoint any one drug, much less one brand name, as superior to the others.

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