In Pain?

SUNY Upstate doctor discusses what’s the best over-the-counter painkiller you can take

By Matthew Liptak


Pain is a pain, and when you don’t think there’s a need to see a doctor, there are many over-the-counter pain relievers to treat it. But which one should you get?

In Good Health talked to physician David Lehmann, distinguished service professor of medicine, practicing internist, hospitalist and clinical pharmacologist at Upstate Medical University. He supplied the ins and outs of what you need to know about over-the-counter pain medicine.

So, let’s get to the basics. What actually is pain anyway?

“You can think of it as two big pots.” Lehmann said. “One would be pain from inflammation and then pain from nerve involvement. The latter would be straightforward headache like brain and pain from back pain, a pinched nerve—that kind of stuff. It’s non-inflammatory pain. The inflammatory type of pain would be injury, any type of injury that a person would have involving a joint or soft tissue. Different over-the-counter pain killers work better for different ailments the doctor said.

There are basically four over-the-counter types of pain relievers: acetaminophen, naproxen, ibuprofen and aspirin. Aspirin is no longer a contender as a go-to pain reliever as it’s weaker than the others, Lehmann said.


• The only one of the drugs that is not an NSAID (nonsteroidal anti-inflammatory drug).

• Lehmann said this is the safest over-the-counter painkiller with the least side effects.

• Great for fever and headaches.

• Don’t take as needed (yes, do not take as needed), Lehman advised. Instead take the maximum allowed dose to build up the drug to effective levels in your bloodstream.

• Don’t spend more on extra strength. The additional dosage has no recognizable impact on treating your body’s pain, Lehman said. “There’s no advantage of two tablets of extra strength, which would be 1,000 mgs over 650 mgs,” he said. “Studies have been done. It’s very well documented.”


• Both are nonsteroidal anti-inflammatory drug (NSAIDS).

• Good for joint pain and muscle aches.

• Don’t underdose yourself. Lehmann advises taking the maximum of 800 mgs three times a day to get maximum effectiveness. “You’re behind the eight ball when you’re just taking it for as-needed relief,” he said.

• Don’t take with heart-maintenance dose of aspirin. “When you take naproxen or ibuprofen and you take aspirin for your heart, the aspirin does not work,” Lehman said. “That effect to prevent stroke and heart attack is blocked when you take either naproxen and ibuprofen with the aspirin.” Instead, take your aspirin at least two hours before or after taking the ibuprofen or naproxen.

• Don’t take enteric-coated aspirin which delays the release of the aspirin, as the naproxen and ibuprofen will counteract its effect.

As always if you’re in doubt about using a drug, even over-the-counter, give your doctor a call or ask the pharmacist who is probably right there in the drug store and happy to help.