Over the Counter Pain Relievers
I made this printable handout for my Mutual Assistance Group as I realized one day I did not really know the differences between the Over the Counter Pain Relievers. This is a combination of information from a few different websites. Different websites had different maximum dosage recommendations, but my personal plan is to go with the lowest of the ranges.
Disclaimer: I am not a doctor and this is not medical advice.
Most of this information came from here (I don’t want people to think this is my original work – I just put a bunch of stuff other people did into a PDF):
https://www.verywellhealth.com/what-is-the-difference-between-motrin-and-advil-770459
Properties of Pain Relievers
Each of these popular pain relievers has both benefits and risks. While their general function is more or less that same—to alleviate pain—their mechanism of action and indications for use do vary.
The reasons for using them can include some or all of the following:
- To relieve a headache
- To treat fever
- To alleviate pain, swelling, and stiffness in joints or muscles
- To relieve pain from injury
- To lessen some of the symptoms of allergies, colds, or the flu
The choice of drugs depends largely on the condition(s) you need to treat and the potential problems that may prevent you from using a particular product.
The products themselves can be divided into four drug classes:
- Acetaminophen
- Aspirin
- Ibuprofen
- Naproxen sodium
Ibuprofen, naproxen sodium, and aspirin are all non-steroidal anti-inflammatory drugs (NSAIDs) with a similar mechanism of action. You shouldn’t combine NSAIDs as that can increase the likelihood of side effects. Serious risks of NSAIDs (with the exception of aspirin) include an increased risk of heart attack or stroke.
NSAIDs work by blocking certain proteins, called COX-1 and -2 enzymes, outside of the central nervous system (CNS) and at the site of damaged tissues. COX enzymes are involved in the inflammatory process, so blocking them counters inflammation and the pain it can cause.
Meanwhile, acetaminophen has a mechanism of action that is not fully understood. It’s suspected of targeting a protein that sometimes called COX-3 but is actually a variant of COX-1.
However, it blocks the protein inside the CNS, not outside of it like NSAIDs. This crucial difference means that acetaminophen isn’t effective for inflammation-related problems, such as sprains.
Motrin and Advil (Ibuprofen)
Motrin and Advil are two of the best-known brand names of ibuprofen, which is also marketed under other names. It is used to treat pain, fever, and inflammation, and is commonly used to alleviate the symptoms of a migraine, menstrual cramps, or rheumatoid arthritis
Ibuprofen has fewer side effects than other NSAIDs but can cause heartburn and a rash. It should be avoided in people with kidney or liver problems and may increase the risk of hypertension (high blood pressure) and heart attack if taken excessively.
Best for: Hangover (there you go!), menstrual cramps, sore or injured muscles, sinus pain, earaches, and toothaches
Not great for: Chronic headache
The recommended dose is 200mg or 400mg every four to six hours. However, for arthritis you may need to treat with a slightly higher dose of 300mg to 800mg three or four times daily. If pain persists for more than three days, speak with your physician.
Parents should make sure their child takes these medications with food or water. You should not exceed five doses of acetaminophen in 24 hours. The correct dose for acetaminophen is 6.5mg/lb. The correct dose for ibuprofen is 4.5mg/lb. consult your pediatrician if your child’s condition does not improve with medication.
Ibuprofen: For your safety, do not take more than 1,200 mg in 24 hours.
Aleve (Naproxen Sodium)
Aleve is the brand name of naproxen sodium and is also marketed under other names such as Midol. It treats the same symptoms as ibuprofen, although Midol (which is marketed as a treatment for menstrual cramps) also contains caffeine and a mild antihistamine. The advantage of naproxen is that it remains in the system far longer than other NSAIDs.
Best for: Inflammation, hangover, lasting headache, arthritis
Not great for: Quick pain relief
Compared to ibuprofen, naproxen has a far higher risk of stomach ulcers. As such, it should be taken with food or avoided if you have a history of ulcers or inflammatory bowel disorders (IBD).
The recommended dose for naproxen, brands such as Aleve, is 250mg every six to eight hours, or two 500mg tablets twice a day. To avoid an upset stomach, naproxen should be taken with food.
For your safety, do not take more than 660 mg in 24 hours.
Tylenol (Acetaminophen)
Tylenol is the best-known brand name of acetaminophen. It is also marketed under other names such as Anacin and Panadol. It’s used to treat pain and fever, but it doesn’t help with inflammation.
Best for: Headaches and muscle aches
Not great for: Inflammation and joint pain
Acetaminophen is often combined with opioid pain medication to treat serious pain following surgery. It is generally safe at the recommended dose although a serious skin rash has been known to occur in some individuals.6
An overdose of acetaminophen can cause serious, sometimes fatal, damage to your liver. It’s important that you stay within the recommended dose. Acetaminophen is in a lot of combination products, so be sure to check everything you’re taking.
Unlike NSAIDs, however, the use of acetaminophen is not associated with heart attack or stroke risk. Excessive use of acetaminophen can lead to liver failure, particularly if accompanied by alcohol.
Unless directed by a physician, acetaminophen should not be used for more than 10 days. For adults, the usual dose is 325mg to 650mg every four hours; however, older adults and those with liver disease should check with their physician for appropriate dosing.
Parents should make sure their child takes these medications with food or water. You should not exceed five doses of acetaminophen in 24 hours. The correct dose for acetaminophen is 6.5mg/lb. The correct dose for ibuprofen is 4.5mg/lb. consult your pediatrician if your child’s condition does not improve with medication.
The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.
Aspirin (Acetylsalicylic Acid)
Aspirin, also known as acetylsalicylic acid (ASA), is marketed under the names Bayer, Bufferin, Ecotrin, and an assortment of generic versions. Aspirin is used to treat pain, fever, and inflammation.
Best for: Reducing cardiovascular risk
Not great for: Intense pain
Upset stomach is a common side effect of aspirin. Stomach ulcers and gastrointestinal bleeding can occur.8 This happens most often in older people, those who drink alcohol, take other NSAIDs, or are on blood thinners.
Aspirin should be avoided in children with fever due to the risk of Reye’s syndrome (a form of encephalopathy).
Unlike other NSAIDs, aspirin is not associated with heart attack risk. In fact, it is often taken on a daily basis to reduce the risk of heart attack and stroke, particularly in people considered to be at high risk.
If taken during a heart attack, aspirin can significantly reduce the chance of death. On the other hand, it should not be taken if you are having a stroke as strokes are often caused by the rupture of a vein (rather than by blockage). As such, aspirin can make a stroke worse by promoting bleeding.
For your safety, do not take more than 4,000 mg in 24 hours.
Resources
This is a great chart that can be found in PDF form here: https://www.getreliefresponsibly.com/sites/getreliefresponsibly_us/files/adult_dosing_chart.pdf
A few other great links are:
https://www.webmd.com/pain-management/guide/pain-relievers
https://www.healthline.com/health/pain-relief/otc-anti-inflammatories#uses
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Good advice on taking the lower dose. Unfortunately, people chasing relief, and with no access to other pain meds, will take too much and eat their stomachs up. A friend who does hospital rounds as a pain doc says his primary complaints are of this nature. Death by Ibuprofen….whoda thunk?
Absolutely. In fact, we had a lecture from a nephrologist (Kidney doc) in medical school that pushed for NSAIDs to be prescription only by virtue of their nephrotoxicity alone. The stuff is really violent on your kidney’s. User beware!
Saved as PDF. Thanks for the effort to research this. It’s why I consider myself very fortunate to be married to a Pharmacist.
What few times I required prescription meds, she kept me safe as to side effects and interactions. As you explained in your sterling research, over the counter (OTC) meds need just as much understanding and respect. Just because such are OTC, doesn’t mean safe.
What I once thought, simple vitamins, has interactions with prescription & OTC.
Great article!
Younger service members may, or may not, confirm this, but I read that Combat Medics in the GWOT would give 1000mgs of Ibuprofen and 1000mgs of Acetaminophen for a serious injury, yet not requiring narcotics.
Thank you! This is very well done. I am a pharmacist and will be printing this off for my own reference. If anyone ever has a pharmaceutical question I am here to help. Malachi_Allen on Brushbeater Forum
All nsaids, except aspirin, have an extreme negative effect on the kidneys. Continuous use of nsaids does permanent damage to the kidneys. If you have high bp, or diabetes/prediabetes, you should not use nsaids, at all. If you are healthy, with no problems, and you take nsaids routinely, you will sustain kidney, and liver damage, leading to high bp (controlled by the kidneys), and diabetes! And if you are taking statins, for any reason, you should not take nsaids, at all, as mixed, they have a negative synergistic effect.
Just an important point of clarification here. Aspirin is still nephrotoxic for the same reasons that the other NSAIDs are, but their cardioprotective benefit outweighs their nephrotoxicity (like you mentioned)… even if you have chronic kidney disease (as in diabetes for example). With that said, unless you have CAD or at especially high risk of it with lots of red flags, Aspirin is still doing damage to your kidneys at higher doses typically used for pain control so its use should also be used judiciously.
An 800 mg dose of Ibuprofen will help with the “lower body effects” dysentary and cholera and other stomach problems. You still feel like garbage, but you have a fair warning to take your pants off first.
Great addition, and worth highlighting. It’s still not “settled” but NSAIDs seem to have the effect of inhibiting the overdrive secretion of Chloride into the gut lumen that’s responsible for the “rice water” diarrhea seen in Cholera. This is especially valuable when you consider that in a collapse scenario dysentery has killed more people than combat during conflicts. So in that regard, NSAIDs and especially Pedialyte/Gatorade can be more useful than ammunition (still have that though).
As an important addition to the infectious diarrhea topic, DO NOT take Loperamide (Imodium), an antidiarrheal, because it has an effect of retaining bacterially produced toxins. There is some mixed evidence in the case of Cholera, but you’re not going to be discerning that in a SHTF scenario anyway with a stool test.
Hey, Doc, how do you feel about bismuth subsalicylate (gods Ole Pepto Bismol)in the instances of infections diarrhea? I read somewhere before that it encapsulates the bacteria and helps it be excreted in the feces. It’s been a long time and things may have changed.
Yes! Some literature, though not American (if you’re snobby like that), has indicated that even it reduces the need for antibiotics (like Azithromycin) v. a placebo.
I have had stomach disease after stomach disease for weeks. Eventually your “donut” gets tired, raw, and stops caring. The other problem is that once someone has it, everyone is gonna get it. Even if you wash your hands and clean surfaces. And it keeps going around and around till you have had it 6-7 times in a couple months. I never noticed that it got easier either.
Aleve x1 ( maybe 2 for a loading dose ) + Arthritis Strength Tylenol x2 works great for me. Both have a long duration of action, and different mechanisms of action to attack pain. You can even throw in a narcotic if you have one. Know your health history, and any contraindications before taking any medicines. Your results may vary. This could be reserved for Austere environments where medical help is not readily available, and to be taken on a temporary basis. Not long term.
Outstanding review Patriotman. Thank you. This is worth saving.
Also, you should know these medications can affect blood clotting. Good to know for treating trauma with bleeding.
Anticoagulants such as Heparin, Warfarin, and NOACs are more your concern for increased bleeding especially potential intracranial bleeds in the setting of trauma. Antiplatelets (such as NSAIDs) are usually not a concern. Just don’t give NSAIDs if they’re bleeding out.
Throughout the years, I have gotten better pain relief with iced gel packs.
There are varieties out there, specially the ones one can wrap practically anywhere
with velcro. Buying a few to constantly put the warm one back and take a frozen one
out the freezer/cooler to continue the “therapy”. Even while on the road and even walking around.
I find the simplicity of this really amazing.
I wish people actually tried this method more!
Exactly! Those with turmeric capsules have been immense help for us as pain relief. Great point!
Just be aware that Tumeric is a natural blood thinner as well and should usually be avoided if you’re taking rat poison (coumadin/warfarin).
Correct. Agreed!, the rat poison is something to avoid. Between my Pharmacist wife, her four pharmacists hiking buds, NONE of them care to be on any meds. Their lifestyle is too do whatever it takes to avoid meds.
As for RN’s, I have GREAT respect for all. Good RN’s are truly worth their weight in pure gold. My eldest sister has been an RN all her life and now at 93 still insists that she could clear out half of her ex-hospital with simply staying active and heating healthy.
I put into action throughout the years of pain management to taking the time,
many times weeks to a month or two, and just let the healing process through.
So putting into works the “Loving your enemy”, in this case pain, works with much
patience and perseverance. Took years to understand that “process” during my younger
restless soul years :-)
When this degeneration began, I remember being with Vets (mostly), and many times hearing
them complaining of constipation/stomach problems due to the pills they where taking, so I did
not take pills to this day. The few Epidorals[sp?] given to me back then didn’t help any either.
The Turmeric or better its extract Curcumin I have used in poultices. Never tried BCD or
similar elements/compounds.
So yes, “time heals old wounds” or new ones… provided therapy is followed through calmly
and longsuffering, as healthy as possible. New surprises have popped up too, like “heel spurrs”
and freaking weird and painful locked up shoulder and those too I have managed the same way.
Learned something too about my particular “heel spurr” too, being that it was about ligaments/tendons
on arch to heel that just had to be lovey dovied too :-)
Oh…. alcohol is a toxin too :-(
Great topic here, thank you.
Semper Vivium
MD Here. Spectacular article. If I would have known this was of any interest I would have submitted my own 0.02 on the subject. Alas, Patriotman did an outstanding job covering not only the basics, but going rather in depth. The man is writing about the inhibition of the COX enzymes! It’s a testament to medicine not being voodoo, where only clinicians should opine.
I wanted to dial in on just a few problems with these medications that we see often, which were actually covered above, but added redundantly for emphasis. One was the increased risk of cardiovascular incidents with NSAIDs. This is absolutely the case, but if you’re concerned about a heart attack or have coronary artery disease, high does aspirin (325 mg) ASAP can save your life. If you had a cardiovascular event then you’ll be on baby Aspirin (81 mg) daily. Of the NSAIDs Aspirin is cardioprotective. The next disadvantage that should be highlighted are NSAIDs damage to your kidneys. If you’re prediabetic or have diabetes, stay away! Whenever you take these things just have it in the back of your mind that you’re doing some violence to your kidneys. Unless you’re using baby aspirin for CAD, use these judiciously and intermittently for pain control. Their use for chronic pain control for ailments like arthritis (both osteo and rheumatoid) is where the benefits outweigh the risks (unless you have kidney disease).
Now, Tylenol has the same caution with regard to your liver as NSAIDs do for your kidneys. In fact, Liver damage is slightly more concerning with Tylenol use because acetaminophen is surreptitiously placed in plenty of other OTC medications (i.e. Cough syrup and Nyquil) like the article mentions. You have to really be cognizant about reading the back of these OTC to see if you’re taking in too much Tylenol, where as only NSAIDs are placed in NSAID anti-inflammatory/pain relief medications. Lastly, since both alcohol and Tylenol are hepatotoxic, taking both at the same time is murder on your liver, and you can’t live without one of those.
Bottomline, if you’re going to use these for pain control their use should be alternated and used temporarily if possible for the above reasons.
Oh I definitely took it from another article by someone way smarter that me :)
I just took the information from several different sources and combined it into a pdf for my MAG. None of this is original writing lol
If you are interested in writing on this or any topics at all, drop us a line at info@americanpartisan.com
Will do. Bracken had extended an invite late last year also. You guys write up some great material on the medical front as it is, but I’ll send in a piece if I see a niche worth pursuing.
Absolutely. We would be ecstatic to post it!
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I’m an RN in a Spine and Pain clinic, so I just want to add here that if you are on prescription pain relievers many of them contain doses of acetominophen- such as lortab, norco and percocet. When using otc acetominophen it is important to consider the total amount taken- i.e. if you’re taking norco qid, thats 1300 mg of tylenol, plus whatever you’re taking otc. For your own sake follow the 3000 mg guideline. Liver failure sucks. Alternating Motrin and tylenol works for some folks, and helps keeps the total down for both- if you use common sense. When talking to patients post surgery I highly recommend ice. 10 minutes on/ 10 off, some will say 20/20- ymmv. No direct contact to skin (put a cloth between you and the ice). It does help. There are these ice packs called pancake packs that adhere to your skin shape and are reusable. I have several and they are pretty decent.
Also, speaking of ice, remember the R.I.C.E. acronym for sprains and similar injuries (Rest, Ice, Compression {Ace bandage}, Elevation).
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Great article and great comments. Expedition, remote and Tactical medic here with 30 years experience. I double down on the use of Ice and compression for orthopedic injury. Compressing ice into the tissue works wonders, just not too tight to cut circulation. I also have to add the usage of CBD and good old THC as well. I have seen tons of patients get away from chronic narcotic usage with TCH and CBD. It WORKS and the side effects are minimal, relatively. I often use a 50/50 TCH CBD balm as a topical, and it really works for arthritic and other topical pain. Working during the winter as a Ski Patrol medic, I see tons of ortho, skin and bone injuries and treat lots. Positioning of an injured extremity works wonders as well, as does good quality splinting. I really urge all of you here to look at some classes in remote medicine-RMI in Seattle rules- which uses things you have normally in ones kit, instead of prepared and expensive medical equipment. I would also be happy to write up an article based on my experience and training. Aside from all the meds listed here, I keep a small tube or vial of the balm in my kit, as well as stronger medications which require prescriptions but if your doc trusts your skills, it is not hard to get some. Tramadol is often given for our pets when needed, and it works well for ortho injuries, not as much for H/A or that kind of pain. I make sure that when my dogs no longer need it, to add a few tabs to ones kit.
If you need more info, one can find great books on all this at thrift stores. I just got another Nurses Drug Handbook and a Merck Manual for 5 bucks, both are critical references for ones home medical library.
Just a few thoughts from my perspective!
I had 4 teeth extracted and prior to beginning the procedure suggested we take care of post procedure instructions, paperwork, follow up appt., and prescription for pain meds. The dentist hands me 4 x 200mg. Advil and says trust him this is better than central nervous system pain meds (narcotics) because advil was designed for the ‘peripheral nervous system’ which the mouth (teeth) nerves are included in. I looked at him with great suspicion. He assured me that if it didn’t work he would call in what ever I wanted. Unbelievable; advil worked like a charm. Better than narcotics did for previous extractions. Put advil down for emergency dental pain management in the the ‘go’ kits.