One of the most profitable areas of pharmaceutical sales is in over-the-counter pain relievers.
I recently took a glance at the shelves of a local Murfreesboro pharmacy to count the number of retail pain reliever products that were available.
I stopped counting when I realized the final tally would be several hundred.
As I read the tiny print on as many products as my eyes would allow, I counted only five active ingredients indicated for pain relief.
All of the products were simply various combinations of these few ingredients.
The three most common pain-relieving ingredients are acetaminophen, aspirin and ibuprofen.
Some products contained only one of those single ingredients.
Consumers have a choice of each of those ingredients in liquid, tablet, capsule and occasionally powdered form.
You also have a choice between heavily marketed recognizable brand names, such as Tylenol, Advil, Motrin, Bayer or a generic brand.
Of these three, which ingredient actually works best?
The answer to that question depends on several factors.
Neither product is clearly better than the others in all circumstances.
All three can provide some level of pain relief.
All three also have potential for side effects that can be extremely dangerous.
Acetaminophen is the ingredient in Tylenol and many other pain relievers.
Although acetaminophen can relieve pain and fever, it is often not as effective at reducing inflammation as the other products.
Although advertised on television as being safer, taking acetaminophen can cause a range of side effects that can be deadly in some situations.
Pregnant women or nursing mothers should ask their doctor before taking acetaminophen or any other medication.
Aspirin is the oldest known pain reliever of the most popular options.
The Bayer Company patented the drug aspirin in 1899.
It was soon recognized worldwide as a “wonder drug”.
(The researcher who created aspirin, Felix Hoffman, also created a drug that has a much less favorable reputation: heroin.)
Aspirin reduces pain, fever and inflammation.
It works by blocking prostaglandins, chemicals that are part of the cascade of chemical reactions that cause inflammatory reactions.
Aspirin has a number of side effects, most notably stomach upset and bleeding. This can be severe enough to be fatal.
One side effect that has been found to be beneficial in some people is aspirin’s effect on platelets in the blood.
Aspirin reduces clotting and therefore has been helpful for some people at risk of stroke or heart attack.
Aspirin has been associated with a sometimes fatal reaction in children known as Reye’s syndrome.
Therefore, it is advised that children not be given aspirin at all unless their doctor specifically recommends it.
Ibuprofen works in a way similar to aspirin.
It also blocks prostaglandins.
Ibuprofen can be helpful for pain, inflammation and reducing fever.
It has similar side effects.
It is not associated with Reye’s syndrome, so children’s versions of medicines with ibuprofen are available.
These three ingredients are included singly or in combination in hundreds of formulas available over-the-counter.
That is why it’s crucial to read the labels of any medicine intended to relieve pain.
Many cases of overdosing occur each year because patients or parents do not read the labels of various products.
Patients and parents often combine products without realizing they are doubling or tripling the recommended dose of one of these ingredients.
Often these active ingredients are combined with one another or in combinations that include caffeine.
Caffeine by itself is not a pain reliever, but acts as a stimulant and can enhance the effects of the other drugs.
Another pain reducer and anti-inflammatory not listed above is naproxen.
This is a newer drug marketed as Aleve and other names.
Naproxen can be more effective as an anti-inflammatory than the other drugs for some people.
It also carries risks of internal bleeding, stomach damage and blood thinning.
These products should be used cautiously and only occasionally.
It is important to be aware that each of the drugs has the potential to cause very serious or fatal side effects.
Frequent use can also cause problems such as rebound headaches.
Next week: Simple steps that you can take to avoid the need for pain relievers.
Dr. Mark Kestner