Pain Relievers: Understanding Your Options What types of pain relievers are available over-the-counter? Over-the-counter (OTC, for short) medicines are medicines that you can buy without a prescription from your doctor. OTC pain relievers for adults can be divided into 2 groups: acetaminophen (one brand name: Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs, for short). NSAIDs include aspirin, ibuprofen (one brand name: Motrin), ketoprofen (brand name: Orudis KT) and naproxen sodium (brand name: Aleve). Some products contain both aspirin and acetaminophen (one brand name: Extra Strength Excedrin). Topical pain relievers Topical pain relievers are creams, lotions or sprays you put on your skin to relieve pain from sore muscles and arthritis. Some examples include Aspercreme, Ben-Gay and Zostrix. Some of these contain a medicine like aspirin, but there is no evidence that putting aspirin on the skin works. Other topical medicines "mask" the feelings of pain by making the skin feel warm or cold. Others block the "pain message" from reaching the brain. These medicines are generally safe, even with long-term use. They may be an alternative for people who can't or don't want to use pills to relieve pain. What's the difference between NSAIDs and acetaminophen? Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of hormone-like substances that cause pain(called prostaglandins). Acetaminophen works on the parts of the brain that receive the "pain messages." Will an OTC medicine work as well as a prescription one? For most people, OTC medicines are all they need to relieve occasional pain. If an OTC medicine doesn't help your pain or fever, call your doctor. Or if you've been taking an OTC medicine for more than a couple of days for fever or a couple of weeks for pain, call your doctor. These may be signs that you have a more serious problem or need a prescription medicine. Do OTC pain relievers have any side effects? All medicines can have side effects. However, side effects are usually not a problem for healthy people who only use pain relievers once in a while. Side effects can be a concern for people who regularly use pain relievers or have health problems. If you have questions about side effects, talk to your doctor. Acetaminophen may cause liver or kidney damage in people who take very high doses or who frequently drink alcohol. With long-term use, aspirin and other NSAIDs may cause stomach upset, bleeding in the stomach and intestines, and ulcers. Which OTC pain reliever should I choose? The following advice is for healthy adults who only need a pain reliever once in a while. If you have health problems or regularly use pain relievers, talk to your doctor. Both acetaminophen and NSAIDs work for minor aches and pains, and for fever. Aspirin is generally a good choice for headaches and other common aches and pains. (You should not give aspirin to children because of the risk of Reye's Syndrome.) Acetaminophen is also generally a good choice. Ibuprofen is helpful for menstrual cramps and pain from inflammation (such as muscle sprains). If ibuprofen is not working for you, naproxen and ketoprofen are alternatives. What should I look for on the label? When choosing an OTC pain reliever, check the label for possible side effects or interactions with other medicines you are taking. Always read and follow the directions on the label carefully. If you have any questions, ask your doctor or pharmacist. Who shouldn't take acetaminophen? Unless it is prescribed by your doctor, you generally shouldn't take acetaminophen if you: Have severe kidney or liver disease. Have 3 or more alcoholic drinks a day. Who shouldn't take NSAIDs? Unless thay are prescribed by your doctor, you generally shouldn't take NSAIDs, especially aspirin, if you: Are allergic to aspirin or other pain relievers. Take blood-thinning medicine or have a bleeding disorder. Have bleeding in the stomach or intestines, or peptic (stomach) ulcers. Have liver or kidney disease. Have 3 or more alcoholic drinks a day.