Painkillers: A Guide to What Works

When something hurts, you want a pill that will make it go away now. Our guide helps you figure out which OTC and prescription drugs really work.
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Pain Meds 101

A trip to the drugstore changed my life. When I was a teenager, in the '80s, my periods were rough. I tried those popular pills for pain and bloating, heating pads, pleading with the universe -- but nothing worked. Then ibuprofen became available without a prescription. My next period was a totally different experience. At the first twinge of pain, I popped two pills and was back to normal in 30 minutes.

I'm not the only one who's grateful for painkillers. Women are hit harder by pain than men are -- not just from cramps but also from conditions such as migraines, fibromyalgia, and rheumatoid arthritis. The reason is twofold, says Michel Y. Dubois, MD, professor of pain medicine and palliative care at NYU Medical Center. "There are differences in the pain-processing circuitry between men and women," he says. And estrogen may increase the perception of pain. Some 22 percent of women report severe headache or migraine pain, 30 percent have back pain, and 33 percent have joint pain, according to the National Center for Health Statistics. Up to 90 percent of people with the chronic pain disorder fibromyalgia are women, and migraines are two to three times more common in women than they are in men.

Fortunately, there are a lot more options for managing pain than there used to be. The "grin and bear it" attitude is out and the "get ahead of the pain" approach is in. The main message? Most people can find a medicine that helps them feel better with minimum side effects and risk.

For basic aches and pains

Generic name: Acetaminophen (also known as paracetamol or APAP)

Common brand name: OTC: Tylenol; Prescription: Tylenol 3 (with codeine, for mild to moderate pain).

The basics: No one is really sure how it works, says Ewan McNicol, clinical pharmacist at Tufts Medical Center and assistant professor of anesthesiology at Tufts University, but it seems to control the way pain is perceived in the brain rather than attacking its source. The over-the-counter pain reliever can alleviate headaches, sore throat, and muscle and joint pain -- and reduce fever -- but so can NSAIDs and aspirin (see following categories). "In general, acetaminophen is a safer drug," says McNicol, so many experts suggest trying it first. But NSAIDs or aspirin may work better for some conditions, especially if inflammation is involved.

The issues: While acetaminophen is safe, misusing it can cause liver damage. Don't take more than 1,000 mg at a time or 4,000 mg a day (3,000 mg if you're over 65 or regularly drink alcohol). The major reason people go overboard on the drug is that they unknowingly take more than one medication that contains it. (According to the FDA, more than 600 OTC and prescription products are made with acetaminophen.) For instance, when you have a cold, you might pop acetaminophen to nix the body aches and take a nighttime multisymptom remedy so you can sleep. If that cold remedy also contains acetaminophen, you just took a double dose, so read ingredient lists carefully.

When using acetaminophen in any form, watch your alcohol intake because the combination can harm your liver.

Continued on page 2:  NSAIDs and Aspirin


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