Headache? Joint Pain? How to Choose the Right Over-the-Counter Painkiller


A relative newcomer to the pharmacy shelves, naproxen (Aleve) only was approved by the Food and Drug Administration for over-the-counter use in 1994.

Naproxen is an NSAID with a pain-killing mechanism similar to that of ibuprofen. The drugs have comparable effects and side effects, so the choice comes down to personal preference.

"The anti-inflammatory medications like ibuprofen and naproxen are very good for the common muscle aches from 'overdoing it' (like at the gym or working in the yard) and also help with common arthritis pain," said Collins.

Naproxen -- both Aleve and the generic form -- also was named a "best buy" NSAID by Consumer Reports Health.

When taking NSAIDs, hydration is important because the drugs may reduce blood flow to the filtering mechanism of the kidneys. According to the National Institutes of Health, NSAIDs other than acetylsalicylic acid also can increase the risk of stroke and heart attack.

Talk to a doctor about cardiovascular risk factors before taking NSAIDs regularly.


The drug known by most people as Tylenol is another mild pain reliever. It is not an NSAID, so it won't quell inflammation. However, it won't irritate the stomach, either.

"Acetaminophen is better for people who have stomach troubles," Schmitz said. "It has been a good drug for children as well."

The drug is good for treating aches and pains not related to injury or inflammation. But because it's metabolized in the liver, it can have serious side effects if taken at high doses or with alcohol.

"The most significant danger of high doses acetaminophen is liver damage and even liver failure," said Dr. Doris Cope, professor and vice chairman of pain at the University of Pittsburgh School of Medicine.

Acetaminophen use should be avoided in people who have consumed alcohol or are dehydrated, or who have kidney or liver problems.

Because of its potential to cause serious harm at high doses, people should be careful when taking combination drugs that contain acetaminophen, according to Dr. Carol Warfield, chair of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center in Boston.

Certain prescription painkillers also contain acetaminophen, opening the door for unintentional overdoses.

"In a recent study, fewer than 15 percent of patients knew that commonly prescribed pain medications [such as Percocet and Vicodin] contained acetaminophen," said the University of Pittsburgh's Cope.

Combination Drugs

Over-the-counter medications designed to treat multiple symptoms often contain painkillers in combination with other drugs. Cold and flu medications often contain painkillers as well as decongestants. And menstrual pain relievers often provide diuretics, too.

"I am not a big fan of combination drugs," Schmitz said. "I recommend that people know what they are taking, take specific medicines for specific problems or symptoms, and read the package before they purchase it so that they know what is in it."

Talk to a Doc

When in doubt, ask a doctor or pharmacist for a recommendation or an explanation of a particular drug's ingredients. And during pregnancy, it's important to talk to a doctor before taking any over-the-counter medication.

"It's not a bad idea to find out what might be OK before one needs any OTC medicine at the first OB visit," Schmitz said.

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