How to Choose the Right Pain Killer

The Differences and Risks of Non-Prescription Pain Medications

Sep 19, 2009 Noreen Kassem

There are several over-the-counter pain relievers containing aspirin, ibuprofen or paracetamol, which treat specific symptoms such as pain and inflammation.

Over the counter pain analgesics or painkillers are common drug store purchases for headaches, backaches, muscle and joint pain, sprains, fevers and toothaches. With the different types of pain medications available it is important to choose the right one for specific symptoms. The many benefits of analgesics must also be weighed against their risks. This article discusses the three common types of pain killers sold under brand names.

Paracetamol Is Commonly Used For Pain

Paracetamol (also called acetaminophen) is a common painkiller for headaches, menstrual pain, backaches and general aches. It is also used to bring down fevers and pain from cold and flu symptoms. Paracetamol does not have anti-inflammatory properties, so it is not a good option to treat sprains, swollen injuries and arthritis.

Paracetamol can be taken with food and will not irritate the lining of the stomach, making it the best pain reliever for individuals with acid reflux, ulcer pain or sensitive stomachs as well as for children. It also does not cause blood thinning and is safe for hemophiliacs.

Risks of Paracetamol to the Liver

Paracetamol is the most common form of drug poisoning by a pain reliever and overdoses can cause liver and kidney damage and eventual death. Like most medications, paracetamol is biotransformed in the liver, where liver enzymes called the cytochrome P40 system break down the drug to reactive metabolites that can damage hepatocytes (or liver cells). Under normal circumstances this converted form of paracetamol is joined to another substance in the liver called glutathione, which turns it into a deactivated molecule that can be safely excreted from the body through the kidneys.

However when there is an overdose of paracetamol, glutathione levels are soon used up and the active metabolites of paracetamol cause necrosis or cell death in the liver. This is called hepatoxicity or toxicity to the liver. The liver functions to process all drugs and food chemicals in the body and it is important keep it healthy with foods that detox the liver and by taking medications only when necessary.

Patients with pre-existing liver disease, high alcohol intake, poor nutrition or a history of drug abuse are therefore given much lower than normal doses of paracetamol, when needed. It is easy to inadvertently take higher than recommended doses as many non-prescription medications such as cold, cough, flu, and sinus congestion medicines contain paracetamol. Labels should always be checked and mixing several medicines should be avoided.

Aspirin Reduces Inflammation and Blood Clotting

Aspirin is an NSAID or non-steroidal anti-inflammatory drug. Its clinical effects include reducing pain by blocking nerve signals to the brain and inhibiting the production of prostaglandins, a hormone-like substance which causes inflammation in the body.

It also causes blood thinning by reducing platelet (blood protein) clumping and other factors that cause clotting in the blood. For this reason aspirin has been considered useful in preventing strokes and heart attacks in some susceptible individuals under the care of a physician. Uses include anti-inflammatory for swelling and pain in rheumatoid arthritis, osteoarthritis and sprains. Aspirin is also good for occasional pain such as in toothaches, headaches, muscle pain and cold and flu symptoms.

Risks of Aspirin to the Stomach

Aspirin can cause stomach irritation, indigestion, gastrointestinal bleeding, decreased stomach or gastric mucous production, skin rashes and a decreased flow of blood to the kidneys. The risks of aspirin in higher doses makes it unsafe for general use. Slow-release or coated tablets offer some protection to the stomach. Most aspirin overdoses cause gastrointestinal pain and injury while severe cases can cause coma, convulsions, acidosis of the blood and kidney failure.

Aspirin is broken down to salicylic acid in the liver as well as many other tissues of the body.

Ibuprofen Reduces Swelling and Pain in Arthritis

Ibuprofen is also a non-steroidal anti-inflammatory drug and like aspirin is useful for reducing swelling and pain in arthritis, injury and sprains as well as headaches, menstrual pain and muscle pain.

Ibuprofen is also sold in cream or gel form for mild joint pain and muscle injury. Doses need to be taken ever 6 to 8 hours and it can be taken with paracetamol if extra pain relief is required.

Ibuprofen has similar side effects to aspirin and should be taken after food to prevent stomach irritiation. Individuals with asthma should also not take ibuprofen as it causes wheezing and it should be avoided by those with ulcers, acid reflux, indigestion and sensitive stomachs.

Like all medications, non-prescription pain medications can have serious side effects when used inappropriately. Consult a doctor or pharmacist for more information on taking analgesics and do not self medicate for long periods without the supervision of a doctor.

For further information on arthritis pain, see The Difference Between Rheumatoid Arthritis and Osteoarthritis.

Reference

Clark, Micheal: Clinical Medicine Fifth Edition. W.B. Saunders London, UK 2002

The copyright of the article How to Choose the Right Pain Killer in General Medicine is owned by Noreen Kassem. Permission to republish How to Choose the Right Pain Killer in print or online must be granted by the author in writing.

Pain Killers Have Risks and Benefits

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