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 | Pain Relievers
By Michael Spilane, MD
Take a look at the pain reliever section in a typical drugstore. A bewildering array of brand names beckons your attention. One promises speedy relief, another extra safety, and yet another long-acting relief. Which one do you choose? Most of the labeling represents hypethe drugs are far more similar than they are different.
There are only two basic types of non-prescription pain relievers acetaminophen and non-steroidal anti-inflammatory drugs (N-SAIDs). The 150 or so brand names of pain medications all fall into one group or the other. And within a basic group the various brands offer similar benefits and risks. The real choice is between the two basic groups and not the oodles of brand names available within each group. There are important differences between the two types of non-prescription pain relievers. Acetaminophen provides pain relief alone, whereas N-SAIDs offer pain relief plus the ability to fight inflammation. The anti-inflammatory action of N-SAIDs comes with a higher risk of side effects.
Acetaminophen (for example, Tylenol) is a very effective pain reliever. Most common aches and pains involve only minor inflammation and are best treated with this agent. Acetaminophen is very safe when used according to instructions. Daily dosage should not exceed three grams (eight regular strength tablets) and patients with liver or kidney disease should consult with their doctors before use. Tylenol is the most popular brand name, but other brands may be cheaper. Look for the name acetaminophen in the small print.
Aspirin is the granddaddy of the non-steroidal pain relievers. It differs from other N-SAIDs in its ability to irreversibly alter the function of platelets (blood cells that help in the blood clotting process). Aspirin works well in relieving both pain and inflammation, but the potential for side effects makes it a poor choice for older patients. A good rule is to avoid aspirin unless your doctor advises a tiny daily dose to thin the blood in an attempt to prevent stroke and heart attack.
Other non-prescription N-SIADs include brands such as Motrin and Nuprin (Ibuprofen), Aleve (Naproxen), and Orudis (Ketoprofen). These drugs are like aspirin in their ability to defuse inflammation and diminish pain, but they do the job with less potential for side effects. Which is not to say they are safe. Many geriatricians wish these non-aspirin N-SAIDs were not available without a prescription. The main problem is the potential for stomach ulceration and bleeding. Even short-term use at higher dosage can bring trouble. And in the elderly these agents can also result in serious kidney problems. Ibuprofen was the first non-aspirin N-SIAD available without a prescription, and more than a few different brand names are now available. More recently, cousins of Ibuprofen have hit the shelves. Naproxin and Ketoprofen have marketable differences from Ibuprofen, but the similarities predominate.
In an attempt to peddle more of their product, pharmaceutical companies often add another chemical compound to a pain reliever and tout it as a specific remedy for various ailments or symptoms. If you need pain relief, buy a pure pain reliever. If you need decongestion, buy a decongestant. Avoid the combination stuff.
An older person is well advised to use acetaminophen for pain control. The occasional single or double dose of aspirin or a non-aspirin N-SAID is unlikely to harm, but any regular dosing should be done only after consultation with a physician.
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