Pain really is a pain. Whether you’re dealing with a headache, a sprained ankle or something else, finding relief can make or break your day. However, you want to make sure you’re choosing the right pain medicine. Opioids, for instance, are incredibly effective prescription pain medications, but they’re also highly addictive and their misuse is contributing to a tragic and fatal epidemic in the US.
We asked doctors to weigh in on the pain relief options out there, both over the counter and otherwise. If you’re just experiencing situational muscle soreness or a one-off headache, it’s good to know which pain medicine is most effective. If you’re dealing with chronic pain, however, you’ll want to go the extra mile and see a doctor specializing in pain management.
Ibuprofen
Ibuprofen (widely known under brand names like Advil, Motrin and Midol) falls under the category of non-steroidal anti-inflammatory drugs (NSAIDs). As the name implies, these medications reduce inflammation (one cause of pain) but are not steroids. This is notable because steroids, while also anti-inflammatory, are both more powerful and associated with side effects like high blood pressure, fluid retention, weight gain and even thinning bones. NSAIDs are also different from narcotics, a class of pain-relieving drugs that have numbing or paralyzing properties and includes opiates.
“When managing pain and inflammation, it’s not uncommon for a person to be prescribed an NSAID like ibuprofen,” says Dr. Lewis Jassey, a pediatrician and medical director of Leafwell, a medical marijuana advocacy group. “They’re used by millions of people worldwide without ill effects when dosed appropriately. Unlike narcotic painkillers, they can be used with much less chance of dependence or other effects that can impact quality of life, like sedation.”
However, there are some drawbacks. “Ibuprofen can be highly effective at treating musculoskeletal pain, arthritic pain and menstrual pain,” says Dr. Deepti Agarwal, an anesthesiologist and pain management specialist in Chicago. “That said, it is essential to be aware of the potential risks that come with taking ibuprofen, most commonly, gastrointestinal distress. More seriously, long-term usage can cause damage to the kidneys.”
While taking ibuprofen here and there is generally okay for your kidneys, research has found that long-term use can increase the risk of kidney failure, especially in those with preexisting conditions like chronic kidney disease or diabetes.
Naproxen
Sold under brand names like Aleve, the NSAID naproxen combats pain by counteracting inflammation. The pain medicine is used for many of the same purposes as ibuprofen: joint pain, swelling, menstrual cramps and headache.
Agarwal says there are a few significant differences between ibuprofen and naproxen. For one, naproxen works longer, for typically up to 12 hours. Naproxen can also bring even more intense gastrointestinal side effects than ibuprofen.
Aspirin
The “veteran” of NSAIDs, aspirin has been around for more than 100 years. Dr. Marc Helzer, a family practitioner at University of Michigan Health-West, praises aspirin as nonaddictive, inexpensive, readily available and effective at fighting pain.
It’s a good option for treating headaches, menstrual pain, fever and pain from inflammation in the short term, but aspirin isn’t great for chronic pain. This is because long-term use of aspirin is associated with GI issues like nausea, vomiting, heartburn and even ulcers or stomach bleeding.
Agarwal explains that as a pain medicine, aspirin, “was once hailed as a ‘wonder drug,’ not only for its ability to treat pain, but also because some studies show it can lower your risk of heart attack and certain cancers.”
While doctors used to recommend people take aspirin daily to prevent cardiovascular disease, because of the risk of internal bleeding, the US Preventive Services Task Force now recommends against it in people over the age of 60.
Acetaminophen
You probably know it as Tylenol: Acetaminophen is the only common over-the-counter pain medication that isn’t classed as an NSAID. It’s technically part of a group called “nonaspirin pain relievers.” Agarwal says it’s effective at treating mild to moderate pain or fevers, but not inflammation or swelling (like the pain caused by arthritis or a muscle strain), and is best used for headaches or common colds.
Acetaminophen doesn’t carry the adverse GI effects of NSAIDs, making it a good choice for people with acid reflux or other digestive issues. Because it’s not an NSAID, says Agarwal, it can also be used in tandem with ibuprofen, though “it is essential not to exceed the recommended dosage of either.”
While acetaminophen was long considered virtually side-effect-free, she adds, “research is increasingly proving this to be untrue.” Helzer says high doses of the drug taken over a long period of time can “severely injure the liver.”
Cannabis
You’ve likely heard every argument about using marijuana for pain management or otherwise. The cannabis plant contains several different chemical compounds, or cannabinoids. The most commonly known are THC (tetrahydrocannabinol, the psychoactive chemical that people use to get high) and CBD (cannabidiol, a chemical without any psychoactive effects). These compounds target the endocannabinoid system, a receptor system in our bodies that’s fundamental to the regulation of functions including pain perception and inflammation.
“When the endocannabinoid system is out of tune, this is when health problems can occur, which often includes inflammation,” Jassey explains. “Cannabis can help bring the body back in tune and keep it balanced.”
Regulatory frameworks are not consistent across the United States regarding cannabis use. In most states, you need a prescription to access marijuana for pain management. CBD is more widely available, and one product has even been approved to treat epilepsy by the Food and Drug Administration, though CBD’s legality overall varies widely by state and even municipality.
“When it comes to alternative and unconventional pain management options, there are perhaps none so popular at the moment as CBD,” says Jassey. “It’s extremely well-tolerated by the body.”
That doesn’t mean we know everything about how suitable it is for every potential patient, he adds. While more research is needed, Jassey notes that known potential side effects can include drowsiness, an upset stomach and dry mouth.