OTC Pain Relievers & Fever Reducers: How To Choose

Choosing an Over-the-Counter (OTC) Pain Reliever or Fever Reducer

Nonprescription pain relievers can be used to treat mild-to-moderate pain resulting from a variety of conditions. This leaflet discusses their use in some of the most common pain-causing conditions.

Osteoarthritis

Osteoarthritis is the most common form of arthritis and typically affects the hands and weight-bearing joints such as knees, hips, feet, and the back. People of all ages can have osteoarthritis, but it is most common in older people. Pain in osteoarthritis is caused by the breakdown of bone in the joints. Unlike rheumatoid arthritis, there is very little inflammation.

The American College of Rheumatology recommends acetaminophen as initial drug therapy for osteoarthritis. Acetaminophen has been shown to relieve mild-to-moderate pain in patients with osteoarthritis, is generally safe and well tolerated, and is relatively inexpensive.

Aspirin and other nonprescrlption, nonsteroidal anti-inflammatory, drugs (NSAIDs) such as ibuprofen, ketoprofen, and naproxen sodium can also be used to treat mild-to-moderate pain of osteoarthritis. Older individuals and people who have underlying health problems such as stomach ulcers, kidney disease, heart disease, high blood pressure, or alcoholism are more likely to experience side effects from these medicines than younger, healthy people. Patients taking certain other medicines such as prednisone or warfarin, along with NSAIDs, are also more likely to suffer from side effects than people who are not taking these drugs.

Dysmenorrhea (Menstrual Cramps)

Menstrual cramps are usually caused by the release of naturally occurring substances such as prostaglandins and vasopressin that can affect the activity of the uterus during menses. In some women, cramps result from disease of the reproductive organs that may require treatment other than pain relief. For this reason, all women who develop menstrual cramps should discuss them with their doctors before starting any treatment.

Oral contraceptives (birth control pills) are often used to treat menstrual cramps. They block ovulation and prevent the release of naturally occurring substances that affect the uterus and cause pain.

Nonprescription NSAIDs (ibuprofen, ketoprofen, naproxen sodium) can also be used to relieve mild-to-moderate pain that occurs with menstrual cramps. These medicines can cause side effects. People at greatest risk for side effects include older people and people with underlying health problems such as stomach ulcers, kidney disease, heart disease, high blood pressure, or alcoholism. Patients taking certain other medicines such as prednisone or warfarin, along with NSAIDs, are also more likely to suffer from side effects than people who are not taking these drugs.

Headaches

There are 3 main kinds of headache:

  • Migraine headache
  • Tension-type headache
  • Cluster headache

Nonprescription medications may provide headache relief in some patients. Clinical studies have shown that aspirin, aspirin/caffeine combinations, ibuprofen, and naproxen sodium can provide adequate headache relief in some patients. Acetaminophen is indicated for tension-type headaches.

Patients who suffer from headaches (or pain) regularly or for prolonged periods should talk to their doctors to have their condition diagnosed. Frequent headaches can often be prevented with proper prescription medicines.

Sprains and Fractures

Sprains (ligament tears) and fractures (bone injuries) are associated with pain and inflammation. Many experts recommend using pain medicines that do not interfere with inflammation, as it is an essential part of the healing process. When exceeding nonprescription recommended doses, aspirin and nonprescripfion NSAIDs block inflammation; acetaminophen does not.

Muscle Injuries

There are 3 main types of muscle injuries:

  • Injuries cansed by excessive stretching oi the muscle (often called “pulled” muscles)
  • Injuries caused by a direct hit or blow
  • Injuries associated with intensive abnormal repetitive muscle use (such as running a marathon)

Muscle injuries caused by excessive stretching or a direct hit require inflammation for healing. Others such as muscle soreness associated with abnormal repetitive use (such as running a marathon) are associated with limited inflammation.

Acetaminophen should be considered first-line treatment for patients with muscle injuries, as it can provide pain relief without affecting inflammation that aids the healing process. Other nonprescription pain relievers can inhibit inflammation, but only when taken at doses higher than those recommended on the package labels.

Tendon Injuries

Tendon Injuries such as “tennis elbow” are usually caused by degeneration (break down) of the tendons and can be very painful. There is usually little or no inflammation.

Pain relief is important, as it allows continued use, which can prevent further degeneration. Aspirin and nonprescription NSAIDs may provide adequate pain relief in some patients. Anti-inflammatory effects, such as those that can occur with prescription doses of NSAIDs (higher than nonprescription doses) may actually impair the healing process.

Co-Sponsorship provided by the American Pharmacists Association and SynerMedĀ® Communications
Supported by an educational grant from McNeil Consumer & Specialty Pharmaceuticals

US Pharmacist
Copyright 2003 Jobson Publishing, LLC