Harvard Health Letter

12 things you should know about pain relievers

A dozen take-home messages about the pills that take the hurt away.

Remember when it was so simple? Take two aspirin, call the doctor in the morning. Now we've got a staggering number of pain relievers to choose from. Picking the right one is enough to give you a headache! And whatever you might think about the Vioxx debacle, it certainly made us aware that these medications — even the ones sold over the counter — are serious drugs, capable of doing great harm as well as rescuing us from some awful pain. So here are a few pointers to help you navigate the pain reliever aisle.

Pain relievers at a glance

Brand names

Comment

acetaminophen

Tylenol

Not an NSAID; doesn't cause stomach problems like NSAIDs; common ingredient in headache and cold medicines; large amounts cause liver damage.

NSAIDs

Aspirin

Many brand names

Technically an NSAID, but its anticlotting properties make it unique; alternatives and bleeding risk at high doses means it's not used as much as a pain reliever now.

diclofenac

Cataflam, Voltaren

Used in drops to reduce swelling after eye surgery. As oral drug, may have highest risk of cardiovascular side effects of older NSAIDs.

ibuprofen

Advil, Motrin, Nuprin

Favored because it acts quickly without staying in the body too long, so per dose it has a lower risk of causing stomach and kidney problems.

indomethacin

Indocin

Available as a suppository — valuable when you have nausea as well as pain; headache and dizziness side effects have made it less popular.

naproxen

Aleve, Naprosyn

Longer acting than ibuprofen; may have fewer cardiovascular side effects than other NSAIDs.

piroxicam

Feldene

Very long acting (24 hours), which doctors concerned with NSAID side effects see as a major drawback.

sulindac

Clinoril

Some findings suggest it's easier on the kidneys, but others raise doubts.

COX-2 inhibitors

celecoxib

Celebrex

Low doses (200 mg per day or less) may pose less cardiovascular risk than other COX-2 inhibitors.

meloxicam

Mobic

Replaced celecoxib and rofecoxib in some countries (for example, Australia); pharmacologically in a gray area between traditional NSAIDs and COX-2 inhibitors; less risky than Vioxx; relatively few studies of its risks.

rofecoxib

Vioxx

Pulled off the market in 2004. Associated with kidney and heart risks.

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