What to do about pain relief

This past April, arthritis and headache sufferers were thrown into a panic when the FDA not only pulled another popular prescription painkiller off the market, valdecoxib (Bextra), it announced that all nonsteroidal anti-inflammatory drugs (NSAIDs) -- even the over-the-counter (OTC) ones -- carry stomach, cardiovascular and skin risks.
Does this mean that we should stop taking ibuprofen (Motrin), a popular NSAID? Should we instead turn to acetaminophen (Tylenol), which has been linked to liver problems when taken in excess?
Sometimes you just need to stop the pain -- fast. What to do?
For Pain and Fever Relief
To learn more about the ibuprofen/acetaminophen debate, I spoke with Karen Elizabeth Lasser, MD, MPH, an instructor of medicine at Harvard Medical School and director of ambulatory quality improvement at the Cambridge Hospital in Cambridge, Massachusetts. For simplicity, our conversation, while not promoting specific brands, focused on Tylenol versus Motrin, two popular examples of each drug. She told me that when used correctly, both medicines can be safe and effective in reducing fever and providing temporary relief of minor aches and pains. They can be taken for headaches, muscular aches, backache, arthritis, the common cold, toothaches and menstrual cramps.
In choosing one over the other, you must consider how the drugs work, their risk of side effects, what medical conditions you have and what other medications you are taking. When in doubt, consult with your physician.
How They Work
Tylenol: Tylenol works by elevating the body's pain threshold, so you feel less pain. It's best for blunting the sharp pain following surgery and for chronic low-level pain.
Motrin: Like all NSAIDs, Motrin works by blocking the production of substances in the body that cause pain and certain types of inflammation.
The bottom line: For inflammatory problems such as arthritis, all other things being equal, Motrin is a better choice since Tylenol has no anti-inflammatory properties.
Beware of Side Effects
Tylenol: Liver damage is the thing to watch out for with Tylenol. The potential for acetaminophen to harm the liver is increased with large doses, chronic use or accompanying use with alcohol or other drugs. Note: Acetaminophen overdose even can happen with a normal daily dose in certain vulnerable individuals, such as those who have hepatitis or other liver problems.
Motrin: In April, the FDA asked manufacturers of OTC NSAIDs, including Motrin, to adjust their labels to emphasize the risks of gastrointestinal bleeding, heart attack, stroke and rare but serious skin reactions. NSAIDs also can cause kidney damage.
The bottom line: If you have hepatitis or other liver problems, Motrin may be the better option. Otherwise, when used correctly, side effects of Tylenol are rare. You are better off with Tylenol...

• If you have ulcers or bleeding problems.
• If you are taking a blood thinner.
• If you have had recent bypass surgery or a stroke.
• If you have kidney disease or are taking a diuretic.
• If you have high blood pressure or heart disease.

Drug, Food and Alcohol Interactions
Tylenol: Do not use Tylenol with other products that contain acetaminophen -- for example, some cough-and-cold remedies. (Check the labels.) In combining these, you inadvertently take in too much acetaminophen, which can cause liver damage. Some prescription drugs also should not be taken with an NSAID. To avoid drug interactions, always tell your health-care professional about all of the drugs you take, both prescription and over-the-counter.
Motrin: Because taking more Motrin than recommended can result in stomach bleeding, do not combine it with other products that contain ibuprofen, other pain relievers or blood-thinning drugs. Take Motrin with food or milk if stomach upset occurs.
Tylenol and Motrin: Both interact negatively with alcohol.
The bottom line: Carefully follow label directions, and do not take more of either product than directed. If you consume three or more alcoholic drinks a day, consult your doctor before taking either medication. With Tylenol, this can lead to liver damage. With Motrin, the combination is likely to cause stomach bleeding.
Start Low, Go Slow
Whatever drug you choose, take the lowest possible dose for the shortest possible time. To be on the safe side, limit your use of Tylenol or Motrin to no more than 10 days at the recommended dosing levels before seeing your physician. And as always, keep in mind that popping a pill is not the only answer to every little ache and pain. Effective nonchemical antidotes to pain include strategies from exercise and stretching to meditation and biofeedback.