FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[IN OVER-THE-COUNTER PAIN MEDICINE, CHEAPER USUALLY BETTER]

Question: I see many advertisements for aspirin, Advil, Tylenol, Excedrin and other pain relievers. Can you offer advice on when one product would be better for me than another?

Answer: Pain seems to be part of the human condition. It is a signal from a body part which isn't working as it should be and serves to focuses our attention on it.

Because aches and pains are prevalent, it is fortunate that remedies for them are, too. The products you mentioned Ê aspirin, Advil, Tylenol and Excedrin Ê are on the shelves of essentially every grocery store, pharmacy and gas station. Each works quite well to relieve most of life's annoying aches and pains and also fever. One isn't better in all circumstances than the other, but there are times when you may wish to try one over the other.

Aspirin is the oldest of the common pain relievers and sets the standard of effectiveness and safety against which the others are judged. Its power to bring pain relief is unsurpassed by newer drugs. For a given problem, however, you may find that a different product works better for you. For most situations, though, aspirin is still the best.

Originally, the Bayer Co. of Germany had a patent for aspirin, but because it has been on the market since the last century, the patent has expired. This means that aspirin Ê also known as acetylsalicylic acid Ê is now in the "public domain" and any drug company can manufacture and sell it. That is why it is very inexpensive and sold under so many different brand names.

Aspirin's major drawback is that it often causes stomach irritation, which can range from a mild stomach upset to a bleeding ulcer. You can reduce this problem by taking an enteric-coated aspirin product or by using an aspirin tablet that contains an antacid in addition to the acetylsalicylic acid. Also, taking aspirin with food helps reduce stomach irritation. However, these measures will not eliminate the problem. That's why I usually recommend that my patients with stomach troubles use a non-aspirin pain reliever.

Tylenol is a brand name under which several products are marketed. "Regular" Tylenol contains the generic drug acetaminophen, while other Tylenol-brand products include additional ingredients. Tylenol works no better than generic acetaminophen, so purchase the most economical one when you have aches and pains. Acetaminophen won't cause stomach irritation, so it is the pain reliever of choice for millions of people. Even if you don't have a sensitive stomach or bleeding disorders, it is a good second choice when aspirin fails to give relief of symptoms.

Excedrin is a mixture of aspirin, acetaminophen, and caffeine. It works quite effectively, particularly for migraine pain. It is a poor choice to take before bed, however, because of the stimulant effect of the caffeine. Taking two Excedrin is like washing down aspirin and Tylenol with a cup of coffee. The caffeine that is mixed with the aspirin can be an additional irritant to the stomach.

Motrin is one brand name for the drug ibuprofen. It is effective for aches, pain and fever, just like the other medicines you've mentioned. It can cause some stomach upset, but it does this less than aspirin but more frequently than acetaminophen. The generic ibuprofen works as well as brand name products, so once again, choose the one that is the best value.

The best additional guidance I can offer is to take that pain signal seriously. All of us experience occasional problems for which any of these products should work well. Persistent or repeated pain, on the other hand, may be the consequence of a problem that you should bring to your physician's attention.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.