How to choose an over-the-counter pain reliever

Over-the-counter (OTC) pain relievers can help alleviate minor aches and pains, and some also reduce fevers. Because you can purchase them without a prescription, they can be a convenient solution for pain. However, you should still consult your healthcare provider before taking any new over-the-counter pain reliever for the first time.

Which over-the-counter pain reliever is right for you depends on a number of factors, including the cause and type of pain, what other medications you take and your medical history.

View acetaminophen products

Available in generic form and sold under the brand name Tylenol, acetaminophen is a pain reliever that’s taken by mouth. Although its method of action isn’t fully understood, the drug seems to work by acting on the brain.

Benefits and usage

Acetaminophen can temporarily ease mild to moderate pain due to a variety of causes, including:

• Backaches
  
• Colds
• Headaches
• Menstrual cramps
• Muscle aches
• Sore throats
• Osteoarthritis

In addition, acetaminophen can lower fevers. The biggest benefit of the drug is that it has fewer potential side effects than nonsteroidal anti-inflammatory drugs (NSAIDs).

Side effects and risks

Like all medications, acetaminophen does pose a risk for side effects. The most common are generally not serious and include:

• Difficulty sleeping
  
• Headache
• Nausea
• Upset stomach

Some people are allergic to acetaminophen and may experience severe reactions, like hives, difficulty breathing and swelling of the face, if they take the drug. Other more serious risks of taking acetaminophen include liver injury and irritation or loosening of skin.

Because it is metabolized by the liver, use caution with the amount of acetaminophen you take and avoid exceeding the recommended or prescribed dosing. If you have a history of liver disorders, consult your healthcare providers prior to using acetaminophen.

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Rather than acting on the brain, NSAIDs help lower the number of substances called prostaglandins that are present in the body. These hormone-like lipids play a role in both pain and swelling. As a result, NSAIDs can relieve both pain and inflammation.

Aspirin, ibuprofen and naproxen are all over-the-counter NSAIDs taken by mouth. Each of these medications has unique characteristics.

View aspirin products

To alleviate pain, aspirin interferes with the production of prostaglandins. The medication is available in generic form and sold under various brand names, such as Bufferin and Bayer.

Benefits and usage

Healthcare providers may recommend aspirin to lower fevers or alleviate discomfort associated with many conditions, including:

• Headaches
  
• Menstrual cramps
• Muscle aches
• Osteoarthritis
• Toothaches

Because the medication has a thinning effect on the blood, it is also sometimes used to reduce the risk of blood clots, strokes and heart attacks. Because the drug can thin the blood and lead to side effects involving bleeding, consult your healthcare provider before using aspirin if you are taking other blood thinners. Even herbal supplements may have some blood thinning properties, so it’s always best to consult a medical professional about taking aspirin with other drugs and supplements.

Side effects and risks

The most common side effects of aspirin are minor and include nausea, vomiting, upset stomach, heartburn, loss of appetite and headache. Aspirin does have the potential to cause more severe side effects, such as:

• Allergic reactions
• Bleeding
• Ringing in the ears
• Kidney injury
• Liver injury

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Another NSAID, ibuprofen is the active ingredient in Advil and Motrin and is also available in generic form. It reduces fever and eases pain and inflammation by disrupting the production of prostaglandins.

Benefits and usage

Like aspirin, ibuprofen can be used to ease discomfort associated with many conditions. Some common uses of ibuprofen include:

• Backaches
  
• Headaches
• Menstrual cramps
• Muscle aches
• Osteoarthritis
• Pain due to the common cold
• Toothaches

Side effects and risks

Generally, ibuprofen is gentler on the stomach than other NSAIDs. However, the drug can cause an upset stomach and nausea in some people. Other common side effects include headaches and loss of appetite. If you have a history of gastritis, gastroesophageal reflux disease or any kidney disorder, consult your healthcare provider before taking ibuprofen. The drug can also thin the blood, so use caution if you are on any blood thinners.

More serious health risks associated with ibuprofen include:

• Allergic reactions
  
• Bleeding
• Heart attack
• Heart failure
• High blood pressure
• Kidney injury
• Liver injury
• Redness, blistering and peeling of skin
• Stroke

View naproxen products

In the pharmacy, you can find naproxen over the counter in generic form and in brands like Aleve. This NSAID relieves pain, reduces swelling and lowers fevers by interfering with the production of prostaglandins.

Benefits and usage

Compared to other NSAIDs, naproxen remains in the body longer, so it can deliver benefits for a longer period of time. You can typically take fewer doses of naproxen for all-day pain relief. This medication can address many types of mild pain, such as:

• Backaches
  
• Common cold
• Headaches
• Menstrual cramps
• Muscle aches
• Osteoarthritis
• Toothaches

Side effects and risks

Risks and side effects of naproxen are similar to those associated with ibuprofen. Its most common side effects are upset stomach, loss of appetite, headache and nausea. The following are some serious risks of taking the medication:

• Allergic reactions
• Bleeding
• Heart attack
• Heart failure
• High blood pressure
• Kidney injury
• Liver injury
• Redness, blistering and peeling of skin
• Stroke

Naproxen may not be safe for people who have a gastrointestinal condition, kidney or liver disease, as well as those who take blood thinners. Speak with your healthcare provider if you have a medical condition or are taking any medications before using naproxen.

View topical ointments and rubs

With topical pain relievers, you apply an ointment, rub, gel, cream or patch directly to an area where you’re experiencing pain. There are many types of topical products that you can purchase without a doctor’s prescription, including all of the following medications:

View diclofenac products

A member of the NSAID class of drugs, diclofenac works by stopping the body from producing prostaglandins. It typically comes in a gel form.

Benefits and usage

Most often, healthcare providers recommend diclofenac for arthritis pain. It may be applied to the knees, ankles, feet, hands and other areas.

Side effects and risks

Because diclofenac is an NSAID, its common side effects are similar to those of ibuprofen and naproxen. The topical gel can cause headaches, upset stomach, loss of appetite and nausea. More serious health risks of diclofenac include:

• Allergic reactions
  
• Bleeding
• Heart attack
• Heart failure
• High blood pressure
• Kidney injury
• Liver injury
• Redness, blistering and peeling of skin
• Stroke

Ask your healthcare provider before combining diclofenac gel with oral NSAIDs like aspirin, ibuprofen or naproxen. If you have a history of stomach or kidney issues, consult your healthcare provider before using topical diclofenac.

Available in rubs, creams, ointments and patches, counterirritants work by making the skin feel hot or cold. The sensation may temporarily block the brain’s ability to detect pain signals. Menthol and capsaicin are two common over-the-counter counterirritants.

Benefits and usage

Typically, healthcare providers recommend counterirritants for muscle aches, arthritis and other types of joint pain. Compared to some other types of topical pain relievers, counterirritants have fewer potential side effects.

Side effects and risks

Counterirritants can irritate the skin, leading to dryness and/or redness. Some people may experience allergic reactions to ingredients found in the topical pain relievers.

Related to aspirin, salicylates disrupt the production of prostaglandins to alleviate pain. These topical pain relievers are available in generic form and in many brand-name topical medications, like Aspercreme, Bengay and Blue-Emu.

Benefits and usage

Typically, healthcare providers recommend salicylates for mild to moderate muscle aches and arthritis pain. They can be a good choice for people who are unable to take diclofenac due to potential health risks.

Side effects and risks

As with counterirritants, the most common side effects of salicylates are skin irritation and dryness in the area of application. More severe allergic reactions are possible. Talk to your healthcare provider before using topical salicylates if you are sensitive to aspirin or taking any other medication.

Available in spray, cream, ointment and liquid solution forms, anesthetics are pain relievers that can be applied to many parts of the body. They work by temporarily deadening the nerves in the area of the application to reduce feelings of pain. Lidocaine and benzocaine are two anesthetics that are sold over the counter.

Benefits and usage

Like other over-the-counter topical pain relievers, anesthetics can help alleviate muscle aches and joint pain. They can also soothe discomfort from skin irritations like burns, scrapes and insect bites.

Side effects and risks

Anesthetics numb the skin, reducing overall sensation in the area of application. Although this is harmless, some people find the feeling unpleasant.

More severe side effects of anesthetics are possible but uncommon. They include:

• Allergic reactions
  
• Breathing difficulties
• Confusion
• Dizziness
• Headache
• Irregular heartbeat
• Nausea and vomiting
• Seizures
• Tremors
• Vision problems

Published November 2023.