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

Experts weigh in on which drugs to take and which ones to avoid.

ByABC News
February 16, 2011, 12:48 PM

March 4, 2011— -- Choosing a painkiller off the drug store shelf can be, well, painful. To offer some relief, Consumer Reports Health released its "Best Buy Drugs" -- a 22-page report that compares the effectiveness, safety and price of some of the top brands (and generics) for pain killing.

The report focuses on non-steroidal anti-inflammatories (NSAIDs), which commonly are used to treat pain associated with arthritis.

But NSAIDs are only one type of painkiller. Depending on the ache, another type might be better. And depending on the sufferer, some drugs can be dangerous.

ABC News asked pain experts to weigh in on what drugs to take for various aches and pains, and when to avoid the drugs.

The drug commonly referred to as aspirin has been around since 400 B.C., when people used salicin-containing willow tree bark to treat pain and inflammation. It was the discovery of salicin as the bark's pain relieving ingredient that led the development of stomach-friendlier acetylsalicylic acid (ASA) in 1838.

"Aspirin was the 'original' headache medication," said Dr. Timothy Collins, associate professor of medicine and neurology at Duke University Medical Center's Pain and Palliative Care Clinic.

But acetylsalicylic acid's anti-inflammatory properties make it good for other types of pain, too, including muscle pain, joint pain from arthritis and toothaches. It's also relatively cheap.

The drug is an NSAID that works by suppressing the production of prostaglandins -- hormone-like molecules that play an important role in inflammation. Unfortunately, the same molecules help to protect the stomach lining.

Acetylsalicylic acid also interferes with blood-clotting thromboxanes. Some people take a daily dose to reduce the risk of heart attack and stroke.

Because of its effects on the stomach and the blood, acetylsalicylic acid isn't right for everyone. People with ulcers, bleeding disorders or kidney or liver problems should avoid it, as should anyone who might be allergic to it.

"There are a lot of other non-steroidal anti-inflammatory drugs (NSAIDs) that have fewer side effects than aspirin so, in many cases, aspirin is not a first choice," said Dr. Mike Schmitz, director of pediatric pain medicine at Arkansas Children's Hospital in Little Rock.

Acetylsalicylic acid use in kids with fevers has been linked to Reye's syndrome -- a potentially fatal disease that attacks the brain and liver. It should only been used in people under 19 under specific orders from a doctor.


Another NSAID, ibuprofen, has pain relieving effects similar to those of acetylsalicylic acid. But it tends to work better even at a lower dose and have milder side effects.

"It is a very good anti-inflammatory medication, originally developed to treat arthritis," said Duke's Collins. "It also lowers fever, and helps with symptoms from the common cold."

The brand name version of ibuprofen is Advil. But only the generic form of ibuprofen was named a "best buy" NSAID by Consumer Reports Health today.

Like acetylsalicylic acid, ibuprofen inhibits prostaglandin synthesis. So it can irritate the stomach and increase the risk for ulcers. It also can cause bruising and bleeding in people who use blood thinners. Ibuprofen should be avoided in people with ulcers, bleeding disorders or kidney disease. But it is not associated with Reye's syndrome and, therefore, can be used in children.