Pain medicines are also called analgesics. Every type of pain medicine has benefits and risks. Specific types of pain may respond better to one kind of medication than to another kind. What takes away your pain might not work for someone else.

OVER-THE-COUNTER PAIN MEDICINES

Over-the-counter (OTC) medications are good for many types of pain. OTC medicines include:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Acetaminophen is a non-aspirin pain reliever. It can be used to lower a fever and soothe headaches and other common aches and pains. However, acetaminophen does not reduce swelling (inflammation). This medicine is easier on the stomach than other pain medications, and it is safer for children. It can, however, be harmful to the liver if you take more than the recommended dose. See: Acetaminophen overdose

NSAIDs include aspirin, naproxen, ibuprofen, and several others that require a prescription. These medicines relieve pain, but they also reduce inflammation caused by injury, arthritis, or fever. NSAIDs work by reducing the production of hormone-like substances called prostaglandins, which cause pain.

DO NOT give aspirin to children. Reye syndrome is associated with the use of aspirin to treat children with viral infections, such as chicken pox or the flu.

If you have high blood pressure, kidney disease, or a history of gastrointestinal bleeding, you should talk to your health care provider before using any over-the-counter NSAID.

PRESCRIPTION PAIN MEDICINES

Prescription medications may be needed for other types of pain. COX-2 inhibitors are a type of prescription painkiller that block an inflammation-promoting substance called COX-2. This class of drugs was initially believed to work as well as traditional NSAIDs, but with fewer stomach side effects. However, numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. Patients should ask their doctor whether a COX-2 drug is appropriate and safe for them.

Narcotic painkillers are very strong, potentially habit-forming medicines used to treat severe pain. They include oxycodone, hydrocodone, morphine, and codeine.

Talk to your doctor if your pain lasts longer than a few days, if over-the-counter pain medications do not relieve your pain, or if other symptoms develop. A pain specialist may be needed to help manage long-term pain.

ALTERNATIVES TO PAIN MEDICINE

You might ask your doctor about alternatives to pain medicines, which include:

• Heat
• Ice
• Massage
• Rest
• Biofeedback
• Relaxation techniques

Max MB. Pain. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 28.