NSAIDs or Acetaminophen: Which pain reliever works best?

It’s bound to happen at some point – a backache, knee or hip pain, a headache, fever, or cramps.  You head to your medicine cabinet or make a trip to the pharmacy seeking relief by trying to make the all-important decision – choose an NSAID or acetaminophen? 

When mild to moderate pain strikes, most of us can treat it on our own by taking an over-the-counter (OTC) pain reliever.  Even though there is a wide variety of different brand names and packages offered, there are basically two major types of OTC painkillers – an NSAID or acetaminophen.  These two types are the most common options for us and either one can provide significant relief from pain. 

However, both types of medications can have a host of side effects.  If these OTC medications are taken only occasionally, there should be few if any concerns for worry.  But, if you are finding yourself relying on these OTC painkillers frequently on a long-term basis for a chronic condition such as arthritis, it is imperative to discuss with your doctor your potential personal health risks from using them.

Since very few of us would be able to live without these OTC pain relievers, let’s take a look at which one – NSAIDs or acetaminophen – is the right choice for what you need and if you’re using it correctly:

·      NSAIDs

NSAIDs are among the most common pain relief medicines in the world used to soothe headaches, sprains, arthritis symptoms, and other daily discomforts.  Aspirin (Bayer, Excedrin) Ibuprofen (Advil, Motrin) or Naproxen (Aleve) is examples of common NSAIDS.

They are designed to inhibit the activity of COX-1 and COX-2 enzymes which cause pain.  These enzymes are produced by the cells of the body and are responsible for the creation of agents called prostaglandins, which promote inflammation, pain, and fever. 

NSAIDs may be more effective than acetaminophen for certain conditions because they have the ability to reduce inflammation as well as relieve pain.  Conditions NSAIDs are often used for include fever, menstrual cramps, sinusitis, backaches, muscle soreness, earache, or toothache. 

Most people who use NSAIDs don’t have any serious problems with them.  But in some, especially those who need pain relief regularly, there can be a downside.  Even though usually very effective for the purpose of bringing relief, when taking an NSAID, it affects your entire system, not just the part that hurts.  Therefore, NSAIDs can have side effects in other parts of your body with the most common one being stomach irritation, particularly if NSAIDs are used for a prolonged period of time. 

Prolonged use can result in leading to stomach and intestinal ulcers, which can lead to severe stomach bleeding, heartburn, GI upset, and constipation.  Their use can also lead to an increased risk of kidney failure, heart attack, and stroke when taken at high doses or for long periods of time.

They are not to be used before or after heart surgery and do not use if allergic to aspirin, naproxen (Aleve), or other NSAIDs. 

Always discuss with your doctor about what the proper dosage should be when taking an NSAID and for how long they can be taken.

·      Acetaminophen

Acetaminophen is a pain reliever and fever reducer.  The most commonly known and used acetaminophen is Tylenol.  This pain reliever has the advantage over NSAIDs in that it is easy on the stomach. 

Acetaminophen has been around since the late 1800s and was approved for use by the U.S. Food and Drug Administration in 1950.  It also works by inhibiting the synthesis of chemical messengers called prostaglandins, which help to transmit pain signals and induce fever.  The body produces prostaglandins in response to an injury or illness.  Acetaminophen reduces the pain by helping to block this signaling.  This medication can stop some prostaglandin functions while not affecting others.  Prostaglandins are known to promote inflammation and swelling of many body tissues.  Unlike NSAIDs, acetaminophen does not have anti-inflammatory abilities.

Acetaminophen is considered better for relief from headaches and arthritis but the most common dangerous side effect is that if taken at high doses, it is toxic to the liver.  The drug itself is not toxic, but a toxic compound is formed (N-acetyl-p-benzpquinonimine) from it as it is broken down by enzymes in the liver. When acetaminophen is taken in small amounts, this compound can be detoxified and excreted.  But when taken in large amounts at once, it can overwhelm the detoxification system and the compound begins killing liver tissue.  This can result in damage to your liver and perhaps permanent damage.   

The recommended maximum dosage per day is generally set at 4 grams (4,000 milligrams) which is equivalent to eight extra-strength Tylenol tablets.  But for some people, that can still cause liver problems. 

To avoid excessive dosages, the FDA now recommends using products containing no more than 325 milligrams per pill or capsule. Be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.

Do not take acetaminophen if you consume 3 or more alcoholic drinks a day or if you have liver disease. 

Bottom line

When considering taking an NSAID or acetaminophen, keep in mind that sometimes one can be more effective than the other depending on your goals for symptom relief.  Generally, if used correctly and in moderation or for occasional pain relief, both types can be very effective.  But always be mindful that each medication can have risks and some can be significant.

The best advice is to always discuss with your doctor which medication is best for you and which may be too risky for you to use.  Always follow dosage directions carefully and let your doctor know how often your use these painkillers.