The Definitive Guide to Pain Pills: Which Painkillers are the Right Painkillers?


Whether it’s the odd headache, monthly menstrual cramps, bruising, or muscle fatigue, we all suffer from pain. And when the pain is intermittent and rare, as it thankfully is for many of us, we tend to rely on over-the-counter pain pills to stop it in its tracks. While these painkillers are indeed useful in many cases, they tend to be overused or even misused.

Dr. Matthew Brennecke, Board-Certified Naturopathic Doctor practicing at the Rocky Mountain Wellness Clinic in Fort Collins, CO, prefers using natural therapies over pharmaceutical medication when possible, so as to limit side effects to treatment. He sees a variety of patients with a range of chronic conditions. He addressed our questions and concerns about painkillers.

Breaking Down the Three Major Pain Pills

When it comes to over-the-counter pain relief, it may seem that you have tons of choices, but as Dr. Zain Razvi, PharmD of Dr. Z’s Pharmacy explains, “If you are looking for a typical over-the-counter medication you are probably going to choose between Tylenol or one of the non-steroidal anti-inflammatory drug (NSAID) products available such as Motrin or Aleve.”

Regardless of brand name, most over-the-counter pain medications can be sorted into one of three categories based on the main active ingredient: ibuprofen, acetaminophen, and naproxen sodium.

Both ibuprofen and naproxen sodium are NSAIDs, or non-steroidal anti-inflammatory drugs. According to Brennecke, both “generally offer you the same relief to whatever is causing you pain.” This is due to the fact that both drugs work in pretty much the same way: inhibiting cyclooxygenase 1 & 2, also known as COX enzymes, which produce the prostaglandin lipids that are produced at sites of tissue damage or infection. These prostaglandins are involved in the body’s natural way of curing small ailments, but they are also the culprit behind much minor pain.

But if both ibuprofen and naproxen sodium work to reduce these prostaglandins, why not just stick to one? The answer comes not in how they work but in how quickly.

“Ibuprofen is fast acting and will bring relief much quicker than naproxen will,” says Brennecke, which is why Advil tends to be the frontrunner in terms of over-the-counter pain relief. That being said, ibuprofen is not recommended for those with cardiovascular problems. “If you’ve had a previous heart attack, naproxen sodium would be a better choice over ibuprofen,” he says.

As for the third drug on our list, acetaminophen, we remain a bit in the dark, at least as to how, exactly, it works. “Acetaminophen (…) is a bit of a mystery,” says Brennecke. “Throughout all of our clinical research, we do not have a complete answer as to how acetaminophen works exactly.”

What we do know is that acetaminophen is a non-opioid analgesic, or general pain reliever, that works much in the same way as other over-the-counter pain meds, by inhibiting COX enzymes and blocking the production of prostaglandins. It also has fewer side effects than ibuprofen, something that, unfortunately, is an increasingly problematic issue due to the over-use of pain medications today.

“The difference between acetaminophen and other non-opioids is that acetaminophen does not block COX enzymes in the peripheral nervous system to an appreciable extent,” says Brennecke. “It seems as though it only blocks pain in the central nervous system by more than one mechanism, possibly working on endocannabinoid receptors or possibly in part by inhibiting a form of COX known as COX-3, but this is still up for much debate.”

“Medications are widely overused, especially in the United States,” says Brennecke, and this over-use can result in some serious side effects. Ibuprofen, for example, can result in gastrointestinal problems when taken regularly, according to Brennecke, including peptic ulcers. Other side effects include ringing in the ears, higher blood pressure, liver toxicity and kidney toxicity, and even heart problems. While acetaminophen does not have the same gastrointestinal side effects, it can cause liver problems, and naproxen sodium is linked to liver disease, internal bleeding and hemorrhaging in the most severe of cases.

It’s all enough to make you turn straight to the natural pain relievers, but there’s one problem: pain relief in the case of natural methods is usually quite a bit slower than with over-the-counter medications. “Ultimately, we live in a “quick-fix” society and most people don’t want to look at their health in a preventative aspect, but rather throw a band-aid on the problem and forget about it,” says Brennecke.

With this in mind, we’ve addressed some of the most common pain problems and the best ways to resolve them, either with over-the-counter pain relievers or natural products.

Headaches: Hydrotherapy or Ibuprofen

There’s a reason why Advil is one of the most common painkillers on the market: the active ingredient, ibuprofen, is one of the best general pain relievers or analgesics, making it Brennecke’s choice for general headaches and aches and pains.

But Brennecke notes that possibly an even better pain relief method is one that uses no medication whatsoever. “Heat and cold therapy, also known as hydrotherapy, is an effective way to deal with pain without taking any medications,” says Brennecke.

Because pain in the case of headaches is due to increased pressure in the area, relieving the pressure will relieve the pain. “By applying a cold cloth on the forehead and applying a hot bath towel to your feet, you draw blood away from the head,” says Brennecke. “The cold vasoconstricts and the heat vasodilates, effectively working as a pump to draw blood away from the cold area.”

Joint Pain and Injuries: Hydrotherapy or Naproxen Sodium

Hydrotherapy can also be used with joint pain, according to Brennecke. “Using alternating hot and cold as therapy can be quite effective in moving stagnant fluid within your body, whether it be blood or excess fluid build up in an injured area.” For this reason, it’s a great technique for helping with sports injuries, sprains or general joint pain.

But as for an over-the-counter pain medication, Brennecke recommends naproxen sodium over ibuprofen in this case. “Naproxen sodium is a drug that works slower than ibuprofen, but will offer longer-term relief,” he says. “It targets muscle tissue inflammation from sprains, strains, or arthritis.” That means that while you might have to ice the joint a bit longer, you’ll end up feeling better all day long and not just for a matter of hours.

Migraines: Natural Remedies, Magnesium, and Ibuprofen (as a last resort!)

According to Dr. Brennecke, over-the-counter painkillers are not the best weapons against migraines.

“The absolute best painkiller to ease migraines in prevention,” he says. “Migraines can be the result of nutrient deficiencies, food sensitivities, hormone balance, abnormal platelet functioning, medications, low blood sugar, and diets high in amines, MSG, and nitrites.” In other words, a whole bunch of different poor dietary choices can lead to an increase in these debilitating headaches, and by making the correct dietary choices, you can often avoid them or decrease the frequency.

But many choose not to make the lifestyle choices that could help them and end up popping over-the-counter pills to ease the pain. According to Brennecke, however, this isn’t even all that helpful — for people continuing to suffer from migraines, he would suggest magnesium, either intravenously or orally.

“Magnesium is an electrolyte and is the most common nutrient deficiency in Americans,” says Brennecke. Without enough magnesium, your blood may not be able to move freely enough in your bloodstream, thus leading to the headaches.

As a last resort, Brennecke does suggest ibuprofen as the best of the three to counteract migraine pain.

Fever: Ibuprofen or Acetaminophen

Again, ibuprofen wins out, but you may want to take an acetaminophen instead if you suffer from frequent pain.

“Acetaminophen also does not possess any anti-inflammatory properties, which is to say that it can be used for fever or headaches, but won’t work to relieve the pain from a muscle strain,” says Brennecke. This means that if you need to choose a medication to help ease a fever, you might want to take the one that you take more rarely to reduce the possibility of increased risk of side effects.

Chronic Pain

With chronic pain, as with all unexplained pain, always seek out the opinion of your primary care physician first. But there are other options, aside from the big three OTC medications, that can be used in these cases.

As Dr. Razvi explains, “If a person experiences pain as a result of an injury or a chronic health condition, prescription pain treatment may be necessary. Muscle relaxants help to treat many sports injuries. ‘Neuropathic’ pain treatments exist to target nerve ending and reduce the burning pain associated with diabetic foot neuropathy.”

Of course, these medications have their own side effects, which is why many experts today are suggesting natural pain relief as an option with more and more frequency, despite their longer reaction time.

“Essential oils are known to produce relaxing effects by combining aromatherapy, massage technique, and herbal ingredient actions,” says Dr. Razvi. “For example, chamomile oil helps to control muscle spasms, and lavender oil has been used to relieve stress and tension.”

But you can also help with chronic pain by making changes in your daily routine, for example, modifying your diet.

“Chronic pain can be relieved by upping your intake of omega-3 fatty acids and decreasing your omega-6 fatty acid intake,” says Brennecke.

“In the United States, the average omega-6 to omega-3 ratio is 40:1,” he explains. “The ideal ratio of omega-6:omega-3 is 4:1.” To improve this ratio, a healthy diet of whole foods and lots of plants is absolutely vital.

Once you have a handle on these three drugs, their ideal uses and their side effects, you can start making educated choices with regards to when to use which drug and when to abstain completely. Starting your pain relief regimen by making good lifestyle choices like staying hydrated and active and heating a whole food, plant-based diet are good places to start!

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Medicine image via Shutterstock

Emily Monaco is a food and culture writer based in Paris. Her work has been featured in the Wall... More about Emily Monaco