Which Pain Reliever is Right for You? In simpler times, when you needed relief from such garden variety ailments as headaches, fever, muscle strain and minor arthritis, you'd reach for aspirin. Today, you must pick from a bewildering array of "regular," "extra-strength" and "maximum pain relief" tablets, caplets, gelcaps and liquid to treat daytime sinus headaches, backaches, sore muscles and menstrual cramps. This confusing cornucopia of pain relievers can be categorized into five types, based on the active pain-relieving ingredient: aspirin, acetaminophen, ibuprofen, naproxen sodium and ketoprofen. For the most part, headaches, nighttime headaches, these over-the-counter (OTC) analgesics work equally well. However, some may be more effective for certain types of ailments, and certain side effects may limit your choice. Knowing the pros and cons of each type of pain reliever will allow you to choose among them. (To keep avoid confusion, all dosage and safety information will be given per tablet, although both should apply for gelcaps and liquids. Consult product labels for more specific information.) Aspirin: Old Faithful Patients have been reaching for aspirin for almost 100 years as an all-purpose pain reliever. "Regular" strength contains 325 mg per tablet; "extra" or "maximum" strength, 500 mg per tablet in the USA--in other countries the dosages are different, so you need to read the label. The usual dosage for adults and children 12 years and older is one to two 325 mg tablets every 4 hours (not to exceed 12 tablets in any 24 hour period) or 1-2 500 mg tablets every 4-6 hours (up to a maximum of 8 tablets per 24 hours). Some brands include caffeine because it can enhance the pain-relieving effects of aspirin. A two-tablet dose provides roughly the same amount of caffeine as a cup of coffee, so you can get the same effect by taking two plain aspirin with coffee. Be CAREFUL-remember that caffeine is a banned substance-when at too high a level. To minimize stomach irritation, some brands are "buffered" with antacids or are enteric coated so pills don't dissolve until they reach the small intestine. You may prefer a buffered formula if you get heartburn or stomach pain when you take aspirin, or if you have arthritis and need to take very high doses every day. When using coated aspirin, keep in mind that they may take longer than plain aspirin to provide pain relief. From Rx to OTC Unlike aspirin, acetaminophen, ibuprofen, naproxen sodium and ketoprofen were once available only by prescription. The Food and Drug Administration (FDA) converted these painkillers to over-the-counter (OTC) status after manufacturers demonstrated they were effective at OTC dosages, which are typically lower than prescription-strength dosages. Also, pharmaceutical companies had to show that they were safe to use by a larger, more varied group of people than would have received them by prescription only -- and without medical supervision. Standard doses for adults and children 12 years and older of these non-aspirin pain relievers vary: two 325 mg or 500 mg tablets every 4 to 6 hours for acetaminophen (not to exceed more than 12 of the 325 mg tablets or 8 of the 500 mg tablets per 24 hours); one 200 mg tablet every 4 to 6 hours for ibuprofen; one 125 mg tablet every 4 to 6 hours for ketoprofen; one 220 mg tablet every 8 to 12 hours for naproxen sodium. Some people may find that an initial dose of two tablets of ibuprofen, naproxen or ketoprofen are more effective for relief of backaches, menstrual cramps, toothaches and injuries accompanied by inflammation than taking a single tablet. However, do not take more than 6 tablets of ibuprofen or ketoprofen (3 tablets, in the case of naproxen) over the course of 24 hours, and do not take more than 2 tablets of ketoprophen in any 4-6 hour period. Acetaminophen is as effective as aspirin in relieving moderate pain and in reducing fever, but less so when it comes to certain types of inflammation, such as bursitis or tendonitis. Though it's no better or faster at pain relief than aspirin, acetaminophen is gentler on the stomach. Also, when combined with the other pain meds, the combination can be even more effective.Finally, when taken for a long time, acetaminophen can cause liver damage. Taken at the recommended adult dosage, the OTC versions of ibuprofen, naproxen and ketoprofen may be a bit gentler on the stomach than aspirin. The effects of naproxen may last somewhat longer than other pain relievers, but there isn't enough data to say how it compares to ketoprofen in this respect. All of these OTC pain relievers can cause gastric bleeding in heavy drinkers, and the FDA now requires warning labels advising people who regularly drink three or more alcoholic beverages daily to consult their doctors on when and how to use these products. Also, people who have bleeding disorders or take anticoagulant medication should avoid OTC pain relievers because they are at increased risk of hemorrhage. Don't take aspirin, ibuprofen, naproxen and ketoprofen if you have an ulcer (symptoms can worsen) or asthma (it may trigger an attack). Avoid aspirin if you have uncontrolled high blood pressure (risk of stroke may increase), liver or kidney disease (these conditions may worsen). Also, combining acetaminophen with alcohol has been lined to liver damage in heavy drinkers. Finally, habitual high doses of aspirin can cause hearing loss or tinnitis -- a persistent ringing in the ears-- and heavy drinkers are especially prone to GI bleeding. Others who should be careful with these medications: Kids and teens should not take aspirin when they have chicken pox or flu because it can cause Reye syndrome, a rare disorder that may cause seizures, brain damage, and even death. Acetaminophen is a better choice to safely reduce fever. Children under 12 should not be given naproxen or ketoprofen except under a doctor's supervision. Pregnant women should avoid aspirin, ibuprofen, naproxen and ketoprofen in the last trimester because of increased risk of stillbirth and of maternal and fetal bleeding during delivery. People over 65 should take no more than one tablet of naproxen every 12 hours, unless directed to do so by a doctor; ibuprofen and ketoprofen do not have special dosing restrictions for this age group. WHAT TO CHOOSE ? When choosing an OTC analgesic, consider safety, strength, speed and duration of action: Do you have any pre-existing conditions that prevent your using one or more types of pain relievers? If so, your only real choice is acetaminophen. What kind of pain do you have? Acetaminophen and aspirin don't effectively relieve menstrual cramps, for example. Ibuprofen, naproxen sodium and ketoprofen are all very effective, but the effects of naproxen may last longer. Is the pain reliever effective at the lowest recommended dose? Taking the lowest possible dose minimizes risk of side effects. If you don't respond to one product or find that it gives you GI problems, switch. Though these drugs are in the same class, you may react differently to them. Pain relievers are intended for short-term use, unless directed by a doctor. Typically, labels advise against taking the product for more than 10 days for pain (for children, the upper limit is 5 days), or more than 3 days to reduce fever. If symptoms worsen, pain persists or you have redness or swelling, see a doctor. Richard T Herrick,MD herrickclinic@mindspring.com www.herrickclinic.com