Take two aspirin and call me in the morning. Or should you take two Tylenol? How about one Advil, one Aleve, and a cup of coffee? What exactly is the difference between aspirin and its near relations?
All these pills are classified as "analgesics," or pain relievers, explains Merle Diamond, M.D., associate director of the Diamond Headache Clinic in Chicago, "but each does it differently." Aspirin, ibuprofen (Advil, Motrin), naproxyn (Aleve), and the recently approved ketoprofen (Orudis KT) are nonsteroidal anti-inflammatories (NSAIDs). They relieve pain by reducing inflammation and the pressure it causes by inhibiting the production of prostaglandin, a naturally occurring compound in the body that can cause inflammation.
There are at least 50 different types of NSAIDs, each composed of a slightly different chemical compound. The ones you know are the most common over-the-counter brands. Some pain relievers combine ingredients—Excedrin has aspirin, caffeine, and acetaminophen; Anacin pairs aspirin with caffeine. "Caffeine improves the absorption through the stomach wall and reduces swelling by constricting the blood vessel walls," says Dr. Diamond.
The other type of painkiller available over the counter is acetaminophen (Tylenol), which reduces pain and fever, but not inflammation. Rather than inhibiting the production of prostaglandin, it affects the pain receptors in the brain. By interrupting the pain pathway, it keeps the brain from getting the signal.
So how do you choose? "We haven't identified what makes one of these drugs work better than another in a specific patient," says Dr. Diamond. "Different people have different responses and tolerances, due to their specific genetic and chemical makeup. You have to try them and trust your own experience."
Some general rules: If you have stomach problems, go with Tylenol. Anti-inflammatories can cause gastric irritation, and Tylenol was developed as an alternative. "Some sixteen thousand people die each year from nonsteroidal anti-inflammatories because of gastrointestinal bleeding," says Dr. Diamond. "They may be more efficacious pain medicine, but if you have kidney disease or problems with ulcers or gastritis, anti-inflammatories are not [a good choice]." NSAIDs, he adds, also should not be taken during the last three months of pregnancy.
Dr. Diamond's suggestions on what to take when:
NSAID. "You need to reduce swelling to reduce pain," says Dr. Diamond.
NSAID. "Cramps are actually caused by prostaglandin, making aspirin or other anti-inflammatories perfect," says Dr. Diamond.
NSAID or acetaminophen (depending on whether there's swelling)
NSAID. "A migraine is a neurochemical change in the brain that produces swelling around the blood vessels," says Dr. Diamond.
Either, but you should opt for the anti-inflammatory if swelling accompanies the discomfort.
"Toothaches have swelling around the gum and inflammation, making a nonsteroidal the best choice."