Knowledge Shot: What over-the-counter painkiller is the best at killing pain

We’ve all had days with nagging headaches, muscle and joint soreness, or general aches and pains, that don’t require medical attention, but require something to take the edge off the pain.

That something is often an over-the-counter, or OTC, painkiller.

There are a variety of brands, which each have different active ingredients, so which OTC painkillers are the best at decreasing pain?

In general, OTC painkillers can be classified in two categories: non-steroidal anti-inflammatory drugs or NSAIDs and acetaminophen.

Inflammation and fever result from pro-inflammatory chemicals called prostaglandins, and NSAIDs work by decreasing levels of these prostaglandins.

The most common OTC variations of NSAIDs include Aspirin which is found in brands like Bufferin and Bayer; Ibuprofen, found in brands like Advil and Motrin; and Naproxen, found in Aleve.

NSAIDs are generally safe, but chronic use can irritate the stomach lining and cause ulcers.

NSAIDs, are also believed to decrease blood flow through the kidneys which can lead to kidney problems in people with other risk factors for kidney disease.

Similarly, while the mechanism isn’t completely clear, NSAIDs, with the exception of Aspirin, can cause cardiovascular damage with extended use.

Finally, NSAIDs have been linked to developmental defects in fetuses so it’s generally recommended for pregnant women to avoid NSAIDs, especially late in the pregnancy.

Unlike NSAIDs, it’s unclear how Acetaminophen exactly works, but it’s thought to block enzymes in the brain and spinal cord that produce chemicals that promote pain and fever.

One key difference though, is that acetaminophen doesn’t decrease inflammation.

It’s found in hundreds of brands like Tylenol, and it’s commonly mixed with other active ingredients as well.

Examples include Excedrin which works for migraines and is a mix of acetaminophen, aspirin, and caffeine; and Vicodin, which is a prescription strength painkiller that contains acetaminophen and hydrocodone bitartrate—a type of opiate.

Acetaminophen is generally safe to use, but using too much of it can harm the liver, especially if you also drink a lot of alcohol or have existing liver issues.

Now, a common question is “how well do these OTC analgesics work?”