Over-the-counter painkillers: What’s the difference?

By MultiCare Health System

What do you reach for when you have a headache?

If it’s not a glass of water or cup of coffee, chances are you’re looking in the medicine cabinet — or your desk drawer — for a painkiller.

But which one do you choose, and why? Tylenol? Ibuprofen? Maybe aspirin?.

  • Acetaminophen (Tylenol).

This common pain reliever is known as an antipyretic (fever reducer) and analgesic (pain reliever). It’s used to relieve mild to moderate pains of many sorts — headache, muscle aches, sore throat, toothache, back pain and cramps.

“Acetaminophen is a highly effective and important pain medication,” says Dr. Jon Geffen, a pain management physician at MultiCare Orthopedic and Sports Medicine – Spine Services.

Avoid taking more than 3,000mg of acetaminophen in a day, as taking too much can cause severe liver damage.

Acetaminophen is not a strong anti-inflammatory, so if you have swelling that’s causing you pain, read on.

  •   Ibuprofen.

Ibuprofen is what’s known as a nonsteroidal anti-inflammatory (NSAID) drug that blocks the inflammatory cascade of chemicals that cause both pain and fever.

“NSAIDs are best for inflammation reduction for autoimmune conditions and traumatic events such as joint injuries or post-surgery pain,” says Dr. Louis Jacobson, a pain management physician at MultiCare Covington Medical Center.

However, many NSAIDs also block peptides that protect your stomach lining, so taking these drugs may lead to stomach upset and irritation. You may prefer an acetaminophen if this is the case.

Because NSAIDs work differently than acetaminophen, you could take them together for pain relief. But avoid taking more than 1,200mg of ibuprofen per day unless directed by your doctor.

  • Aspirin.

Aspirin is a salicylate drug with anti-inflammatory and analgesic properties. Non-prescription aspirin is used to reduce fever and relieve mild to moderate conditions, similar to acetaminophen.

“It works by stopping the production of natural substances that cause fever, pain, swelling and blood clots,” Jacobson says.

But because aspirin has a tendency to thin the blood, it’s not a preferred drug for pain, Geffen says. It should be used to prevent heart attacks or reduce risk of death during a cardiac event such as an ischemic stroke.

Serious side-effects with prolonged use of aspirin include gastrointestinal irritation and bleeding, as well as kidney failure.


A note about chronic pain


Over-the-counter medications are overused by many people suffering chronic pain, says Jacobson.

“Non-prescription painkillers are used like candy,” he says.

Prescription painkillers are also commonly overused. Just last month, the U.S. Food and Drug Administration (FDA) toughened its requirements on labeling for certain types of opioid painkillers in response to growing concern about addiction to prescription painkillers.

Nearly 2 million Americans abused or were dependent on prescription opioids in 2014, according to the U.S. Centers for Disease Control and Prevention. From 1999 to 2014, more than 165,000 people died from overdoses related to prescription opioids.

Whether it’s over-the-counter or prescription painkillers, it’s important to remember these medications are all powerful and should only be used as directed, Jacobson says.

For the over-the-counter medications discussed here, avoid using them for extended periods of time unless prescribed and monitored by a medical provider for a specific condition, such as rheumatoid arthritis or cardiac health.


MultiCare Health System is a network of healthcare facilities and services in Pierce and King counties.Painkillers-web