various pills in different casings

Over-the-Counter Pain Relievers: Which One Should You Take?

May 7, 2024

Maybe you strained your back, have a pounding migraine, achy arthritis, or just got a tooth pulled. Whatever the ailment, knowing which over-the-counter (OTC) pain reliever to reach for in your medicine cabinet can be confusing.

Most people tend to stick with the brands they recognize, such as Advil or Tylenol, but when it comes to managing pain and fever, there are differences in the uses of these common OTC medications. There are two main categories of pain relievers: nonsteroidal anti-inflammatory drugs (NSAIDs)—ibuprofen, naproxen sodium, and aspirin—and acetaminophen. We sat down with Arthi Reddy, MD, assistant professor of medicine at the Vagelos College of Physicians and Surgeons and an internal medicine specialist at Columbia Primary Care Morningside Practice, to find out which relievers are appropriate for what’s ailing you.

What is an NSAID?

NSAIDs block certain chemicals called prostaglandins in the body that cause inflammation and pain from headaches, menstrual cramps, arthritis, and muscle strains. Ibuprofen, the best-known brands of Advil and Motrin, are quick-acting NSAID pain relievers and fever reducers. I

t can cause heartburn and a rash and should be avoided in people with kidney or liver problems; if taken excessively, it can raise the risk of hypertension (high blood pressure) and heart attack. Naproxen sodium, such as Aleve, is a long-acting NSAID, so it takes longer to work but remains in effect for longer, and you do not have to take it as often.

"NSAIDs are not technically analgesics (“painkillers”). They are anti-inflammatory drugs," says Dr. Reddy. "So, after an injury, for example, they reduce inflammation to the area and decrease peripheral and central sensitization. So, they are instrumental in pain associated with inflammation,”

Do People Still Take Aspirin?

Aspirin is an NSAID familiarly known as the brands Anacin, Bayer, or Bufferin. It treats pain, fever, and inflammation and is taken daily in low doses for heart health, as it prevents blood from clotting and leads to heart attack or stroke.

Dr. Reddy explains, “Unlike ibuprofen, aspirin has an antiplatelet effect which can prevent blood clots but also increase the risk of bleeding. Aspirin may also be more likely to cause stomach irritation than NSAIDs. This is why we always recommend not to take any of these medications on an empty stomach. Aspirin is also not recommended for individuals under 18 due to the risk of Reye’s syndrome. You and your healthcare provider will weigh medication’s potential benefits and risks.”

What is Acetaminophen?

Acetaminophen, the generic name for Tylenol, only works in the brain and not the rest of the body. It affects the brain’s perception of pain and regulates body temperature, making it suitable for headaches, toothaches, and minor injuries. It also reduces fever associated with common colds and flu, but it isn’t effective for sprains or rheumatoid arthritis.

Dr. Reddy advises, “Acetaminophen primarily works in the brain, so it is particularly effective as a fever reducer. It also doesn’t have the same adverse effect profile that NSAIDs do and is safe on the stomach. However, it can cause significant liver damage if overdosed, so we caution patients not to exceed more than a certain amount per day in divided doses. This amount is variable, and it can be determined by their doctor.”

Keep in mind that acetaminophen is a common ingredient in many OTC and prescription medications, so be mindful of the total amount you’re consuming from different sources to avoid accidental overdose.

When using OTC pain relievers, it’s essential to read and follow the instructions carefully. Here are a few general guidelines:

  • Start with the lowest effective dose: Taking more than the recommended dosage does not provide additional pain relief and can increase the risk of side effects.
  • Follow the recommended dosing interval: Each OTC pain reliever has a specific duration of action. To avoid overdosing, wait for the recommended period before taking another dose.
  • Consider potential drug interactions: If you are taking any other medications or have underlying health conditions, so talk to your doctor to ensure that the OTC pain reliever is safe and compatible with your current treatment plan.
  • Monitor for side effects: Although OTC pain relievers are generally safe, they can still cause side effects. Common side effects include stomach upset, drowsiness, or allergic reactions. If you experience any unusual symptoms, discontinue use and consult a healthcare professional.

OTC pain relievers are accessible options for managing various types of pain. Understanding the different categories and following the recommended guidelines can help ensure their safe and effective use. However, if pain persists or worsens despite using OTC pain relievers, it’s critical to seek medical advice for further evaluation and appropriate treatment.


Arthi Reddy, MD, is an Assistant Professor of Medicine at the Vagelos College of Physicians and Surgeons and an internal medicine specialist at Columbia Primary Care Morningside Practice.