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.

"There is an honest justification for having different drugs on the market to treat the same condition because different people respond differently to different drugs. That's a fact -- it's a clinical truth," Saper said.

Ingredients Mostly the Same

In most cases, competing brands contain the exact same dosage of active ingredient. Advil, for example, contains 200 milligrams of ibuprofen, as does competing brand Motrin IB. Extra Strength Tylenol contains 500 milligrams of acetaminophen, as does Extra Strength Anacin, which also includes a small amount of caffeine.

The differences in the ever-expanding number of delivery modes are also mostly cosmetic. Tylenol is the leader in creating options, offering its Extra Strength Tylenol in six different pill forms as well as a liquid. Advil and Aleve are packaged in three pill forms, and Bayer offers a safety-coated aspirin pill.

The fancy coatings, with catchy names like gelcaps, cool caplets and liquid gels, are little more than window dressing, experts say. And drugmakers concede that there is little to differentiate the medicine in the pills.

"For everything besides liquid gels it's consumer preference. The liquid gels tend to work faster, and some pills are a little bigger than others," said Fran Sullivan of Wyeth Consumer Healthcare, which makes Advil. "They choose which pill form they like the best."

But even claims of faster-releasing medicine in liquids or pills in "liquid gel" form are not without controversy.

"There's no science that demonstrates that any form of pill or liquid delivers medicine quicker. That's consumer preference -- some people just prefer a tablet or a caplet or a liquid," said Kathy Fallon, spokeswoman for McNeil Consumer & Specialty Pharmaceuticals, the maker of Tylenol.

The Myth of Migraine Labels

In 2000, the FDA permitted drug companies to label pain products as "migraine relievers." Migraine products carry different instructions and labels, but that labeling does not guarantee any difference in actual pain medicine. Advil Migraine and Advil Tablets both contain 200 milligrams of ibuprofen. Excedrin Migraine contains the same combination of 250 milligrams of acetaminophen and 65 milligrams of caffeine as Excedrin Extra Strength.

"If you go to the store and buy a 'migraine' medicine, you might assume -- wrongly -- that it's stronger medicine," Saper said. "It's mostly a marketing gimmick because it's going to be exactly the same drugs."

Certain products also claim to offer relief from "body pain" or "sinus pain," but a glance at the active ingredients shows that they rarely differ much from the standard doses.

For consumers looking for the most appropriate pain relief, the only true way to differentiate between the options is to ask the old standby question: Do you need regular strength or extra strength? Ibuprofen and naproxen products come only in the 200 milligram doses, but regular strength versions of Anacin, Tylenol and Excedrin include a smaller amount of the active ingredient than their extra-strength companion products.

But even that might not be worth worrying about. Experts say taking any of the FDA-approved, over-the-counter products in the suggested dosages is safe for short periods of time, regardless of the strength level.

"You don't want to take more of a drug than you have to, and you don't want to overmedicate. But if you follow the directions, they should be safe," Saper said.

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