Answers to your questions about OTC painkillers – National Consumers League

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Every day millions of consumers turn to over-the-counter (OTC) pain medications for temporary relief of pain from headaches, colds, muscular ache, and arthritis, and to reduce fever. While these medications are largely safe when taken according to label directions, there are risks when taking any drug. Just because a medication is available on the shelf of your local grocery or discount store does not make it any safer than a drug that has been prescribed by your doctor.

Are all OTC pain medications the same?

No. Many different types of pain medications, or analgesics, are available without a prescription. Two common types of OTC analgesics are non-steroidal anti-inflammatory drugs or NSAIDs, and acetaminophen.

  • NSAIDs, or anti-inflammatories, reduce inflammation caused by injury or rheumatoid arthritis. People use them to stop the pain caused by muscular aches, arthritis, headaches, menstrual cramps, and other minor aches and pains. Anti-inflammatories available over-the-counter, or without a prescription, include aspirin (Bayer, Bufferin), ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). These products work by blocking the production of the enzyme COX. There are two forms of the COX enzyme: COX-1 protects the stomach and kidneys, and COX-2 is responsible for inflammation. NSAIDs block the production of both COX enzymes. The stomach irritation and ulcers that can occur with the use of these anti-inflammatories are the result of blocking the production of the stomach-protecting enzyme.
  • Acetaminophen (Tylenol) is used to relieve pain and reduce fever. Because it works mostly on the central nervous system and is not an anti-inflammatory, it does not reduce the swelling or stiffness caused by an injury or rheumatoid arthritis. Acetaminophen is generally less irritating to the stomach than other OTC pain relievers, but may cause liver problems when taken with alcohol or when fasting.

How do I know which OTC pain medication is right for me?

The right painkiller depends on what type of pain you want to relieve and your personal risk factors.

  • If you suffer from arthritis or athletic injuries, anti-inflammatories can reduce the inflammation, but regular use may cause stomach problems or ulcers. Those especially at risk include people over 65 years old, those with a history of ulcers, and those taking steroids or blood thinners.
  • For reduction of fever and relief of pain, acetaminophen, while generally easier on the stomach than other OTC pain medications, has its own risks. Daily use for a long period of time (over a year) may increase the chances of kidney damage. And taking acetaminophen when fasting or with alcohol, even moderate amounts, may cause serious liver problems.
  • If you have a history of kidney, liver or stomach problems (including ulcers), or are allergic to certain pain medications, you should always consult your doctor before taking any type of pain medication. If you take an OTC pain medication for an extended period of time (more than 10 days), you should discuss with your doctor how to best manage your pain.
  • If you are pregnant or nursing, talk to a health professional before using any OTC pain reliever. It is especially important not to take an NSAID during the last three months of pregnancy because it may cause problems for the unborn child.

I heard that NSAIDs relieve arthritis pain. Is it safe for me to take a nonprescription NSAID every day?

Over 14 million arthritis suffers take high doses of aspirin and other NSAIDs, or anti-inflammatories, to ease their symptoms. But continuous use of these drugs can increase the risk of stomach problems. Recent medical studies show that use of OTC NSAIDs increases the risk of stomach bleeding by as much as two to three times. Stomach bleeding caused by NSAIDs is now recognized as the most common serious drug reaction and accounts for as many as 16,500 deaths and over 107,000 hospitalizations per year in the United States. Most of those experiencing NSAID-related stomach problems have no warning signs. There are certain risk factors (for example, age or medical history) that increase the chances of having stomach problems while taking anti-inflammatories.

Acetaminophen can also relieve the pain of arthritis, but not the underlying swelling and inflammation. Continuous, or chronic, use of acetaminophen can also have serious side effects. If you suffer from arthritis pain you should consult a health professional about the most effective and safe way to manage your pain.

If I want more pain relief, can’t I just increase the dose?

More is not necessarily better when taking an OTC pain medication, and it can be dangerous. Read the label carefully and always take the recommended dose, or follow your doctor’s instructions. A third of all consumers take more than the recommended dose of an OTC drug thinking it will increase the drug’s effectiveness. But studies have linked overuse of anti-inflammatories and acetaminophen with kidney and liver problems.

I have a cold and a headache. Can I take two different OTC pain medications at the same time to relieve my pain?

You should be very careful when combining OTC painkillers. Many popular pain medications for headaches and colds combine pain-relieving products. Read the labels of these combination products carefully to make sure you are not taking more than the recommended amount or combining medications unknowingly. For example, one adult dose of Nyquil contains a cough suppressant, an antihistamine, and 1,000 mg. of acetaminophen. If you take the recommended adult dose of Nyquil along with two extra-strength Tylenol, you will have doubled your acetaminophen dose and taken half the recommended daily amount at one time. And the combination of some OTC pain relievers with different active ingredients can create harmful interactions.

Combining anti-inflammatories with antacids or an acid blocker such as Pepcid AC or Tagamet to stop the stomach irritation of anti-inflammatories may actually increase the risk of ulcers. By stopping heartburn symptoms, a warning sign for treatment, the acid blockers may result in late detection, larger ulcers, and even hospitalization.

What about interactions between pain relievers and other substances?

Alcohol — Since alcohol irritates the stomach lining, drinking it while taking anti-inflammatories or acetaminophen can be disastrous. If you drink three or more glasses of alcohol a day you should talk to your doctor or pharmacist before taking an OTC pain medication.

Dietary supplements — You should always know which dietary supplements you are taking, including vitamins, minerals and herbals, since some may interact with OTC pain relievers and cause side effects. For example, Ginkgo, a supplement that thins the blood, may cause excessive bleeding when combined with aspirin.

 

Trends in medicine: What is evidence-based medicine? – National Consumers League

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Doctors and health care professionals are attempting to help patients make sense of the overload of health information by gathering, evaluating, and sharing well–tested, proven medical research. This process of bringing the best available evidence from scientific research to patient care is known as evidence-based medicine (EBM).

The emphasis with EBM is on applying research to medical care: when there is evidence that a treatment works and benefits the patient, it is practiced; where there is evidence that a treatment has not benefited the patient, is ineffective, or harmful, it is not practiced; and where there is not enough evidence, healthcare professionals should proceed carefully.

Many patients are educating themselves about their health, self-diagnosing, and pursuing care on their own.

Some patients are using health information to self-diagnose their conditions and asking doctors to prescribe treatments based on their own research, others are confused by the overload of health information.  To improve health outcomes, doctors and patients should share the responsibility for making health care decisions.

  • Patients are bringing in articles and ads and self-diagnosing specific conditions. This presents an opportunity for doctors and patients to discuss the patient’s actual situation and make appropriate decisions based on shared information.
    • Pharmaceutical ads are a major source of tension because they tell patients to ask the doctor for certain prescriptions by name without knowing if it’s appropriate. Doctors should take the time to explain to patients why the drug is or is not appropriate for them and then discuss other treatment options as well.
  • Doctors can start the dialogue to help patients sort out their questions and concerns.
  • Learning about medical treatments from friends, family and co-workers is a significant source of information that is credible to patients.
  • Often times, patients feel they know what is wrong before seeing a doctor and the challenge is communicating this knowledge to the doctor.
  • Doctors who disagree with their patients’ diagnosis or do not provide them with the desired treatment are often criticized. Shared decision making helps avoid disagreements and leads to successful patient outcomes.

All of the health information now available to consumers is changing the patient/doctor relationship.

Patients’ increased access to medical information is changing the relationship between patient and health care professional.

  • Patients have access to more medical information than ever before through magazine articles, advertisements and online searches, and health care professionals can play a critical role in helping patients differentiate the good from the bad.
  • More patients are taking more responsibility for their own care and want doctors to be partners, not bosses, in this relationship.
  • As America becomes more diverse, we need to pay special attention to cultural, linguistic, and economic barriers that may inhibit consumers from getting the information they need to make appropriate health care decisions.

To help doctors and patients make treatment decisions, it is necessary to sort through health information and find the best medical treatment based on what has been proven to work and is effective

Many doctors and other health care professionals are attempting to help patients make sense of the overload of health information by gathering, evaluating, and sharing well-tested, proven, medical research.  With this research, the health care professional and patient make treatment decisions together based on what works and is effective.

  • Health care systems are working towards a decision-making process incorporating medical research evaluation along with good stewardship – if there is evidence a treatment works and benefits the patient, it is practiced; if there is evidence a treatment has no benefit or may harm the patient, it is not done.  In cases where there is insufficient evidence about a treatment or if evidence doesn’t exist, a consensus is developed among health care professionals and they proceed carefully.  It is a shared decision-making process between patient and doctor.
  • Your doctor uses clinical judgment, incorporating the best research, his/her knowledge and experience, to present you with treatment options.
  • Making decisions based on what has been proven to work helps ensure that you and your health professional choose the most effective and beneficial treatment for you.  Understanding what works most effectively helps spend your health care resources wisely and benefits everyone.

Ask your doctor or other health care professional about how you can decide together what is the best medical treatment for you.

Patients and doctors need to engage in a dialogue about making the best medical treatment decisions.

  • Health care providers are working at bringing together the best available information about health care practices to create and implement programs that help people live healthier lives.
  • Health care providers have created specific care management programs for many diseases, including diabetes, asthma, congestive heart failure, coronary artery disease and depression.
    • Health care professionals stay up-to-date by using a computer system of well-tested medical research that can be used right in your doctor’s office.

Additional Resources about Evidence Based Medicine

To learn more about making health care decisions based on the best medical evidence, check the following resources for quality health information:

Cochrane Consumer Network.  This Web site is part of the Cochrane Collaboration, an international organization that aims to review all healthcare evidence and publishes the reviews electronically. The consumer network website summarizes the reviews for consumers.

MEDLINEplus at www.medlineplus.gov has extensive health information for consumers from the National Library of Medicine and the National Institutes of Health.

The National Committee for Quality Assurance (NCQA) consumer Web site at www.healthchoices.org explains how to choose a health plan based on quality. Includes a Health Plan Report Card.

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) website at www.jcaho.org has information on the quality of care at your local health care facility.  JCAHO evaluates the quality and safety of care for health care organizations.

Kaiser Permanente’s Care Management Institute, www.kpcmi.org, establishes care management programs for patients based on the best available evidence.

To learn more about evidence-based health care and how healthcare professionals are making treatment decisions, Check out the online course developed by CUE (Consumers United for Evidence Based Health Care) on Understanding Evidence Based Healthcare: A Foundation for Action.

About this Web page

These messages were developed by the NCL, in partnership with Kaiser Permanente, to educate consumers about the concept of Evidence-Based Medicine. For more information, contact NCL’s health policy team.