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?
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
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)
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.
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
- Kidney disease, liver cirrhosis or heart
“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
- You can’t cut back on pain medicine.
- The pain seems beyond what you would
- You need more medicine to achieve relief
when a lower dose used to work.
- You’re reaching for a pain reliever 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
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.