April 3, 2019/Primary Care

Stop Before You Pop: What You Need to Know About OTC Pain Relievers

Be smart and safe when using OTC pain killers

Woman reading medication contents and side effects at store

Is there such a thing as a pain reliever that is stronger than the pain? And if it exists, how much is safe to take?


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Each person’s response to pain medication is different; the same dose of a drug that works for others may not for you, says family medicine doctor Matthew Goldman, MD.

So while there’s no one-size-fits-all answer, there are some basics you should understand about those little miracle makers known as pain relievers and how much is too much.

Two types of OTC pain relievers

You probably know that there are two categories of over-the-counter pain medicines — nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics.

NSAIDs such as aspirin, ibuprofen (Advil®) and naproxen (Aleve®) inhibit the body’s cyclooxygenase (COX) enzymes to prevent and reduce pain and swelling. They can be effective against menstrual cramps and muscle soreness.

“Negative side effects like gastric ulcers, heart toxicity and kidney disease can occur as the medicine inhibits the COX enzymes,” Dr. Goldman points out.

On the other hand, analgesics like acetaminophen (Tylenol®), work in the heat center (hypothalamus) of our brain to reduce fever. They may also work on serotonin pathways in our central nervous system to reduce pain.

Analgesics are often a good choice for pain due to headaches or arthritis.


“While the jury is still out on exactly how acetaminophen works, we’re just glad it does,” Dr. Goldman says.

Are OTC pain relief medicines safe?

“I hate to be the bearer of bad news, but some people aren’t candidates for either type of OTC pain reliever,” says Dr. Goldman.

You may be at a higher risk for side effects — or need to avoid OTC pain meds altogether — if you have a history of:

  • Heart disease or high blood pressure
  • Gastrointestinal upset or peptic ulcer disease
  • Kidney disease, liver cirrhosis or heart disease

“Your provider’s role is to guide and support you, so don’t hesitate to reach out to ensure you’re making safe choices with OTC pain relievers,” he says.

Frequent vs. occasional use of pain relief medicines

For most people, though, OTC pain meds are relatively safe for occasional take-the-edge-off-the-pain use, Dr. Goldman says.

“But pain that lingers beyond a couple of days, or that rears its ugly head on a fairly regular basis, is a sign that something isn’t quite right with our bodies,” he adds.

How do you know when the pain has gone beyond “occasional”? Dr. Goldman recommends contacting your provider if:

  • The pain doesn’t resolve within two to three days.
  • You can’t cut back on pain medicine.
  • The pain seems beyond what you would expect.
  • You need more medicine to achieve relief when a lower dose used to work.
  • You’re reaching for a pain reliever week after week.

“I’d prefer to determine what’s causing the pain rather than have you continue to mask it,” says Dr. Goldman. “By getting to the bottom of why you’re having pain, we can hopefully find a solution that delivers consistent, long-term relief.”

The best pain reliever is the one that is the safest for you

So if you don’t have risk factors, and your doctor has told you that OTC pain relievers are a safe choice for occasional pain relief, which one’s the best? You may need to use a little trial and error to see which one works for you, Dr. Goldman says.

He recommends this approach:

  • Start low and go slow: Start with the lowest dose listed on the bottle and see how that goes for a few days.
  • Talk to your provider: If the initial dose doesn’t improve symptoms, call your provider or talk with a pharmacist about increasing the dose.
  • Switch it up: If you need stronger relief, try one pain reliever for one to two days, then switch to a different medication to see what works better.

Some more pain-free news: If you need to level up and get some longer-lasting relief, it’s usually safe to alternate acetaminophen with an NSAID. For example, you can take acetaminophen, then four hours later take a dose of an NSAID and continue to alternate every four hours. You can do this for a day or two, since the medications don’t affect the body in the same way.

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