5 major types of painkillers and how to take each safely

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NSAIDs like ibuprofen work differently from painkillers like acetaminophen. Tom Merton/Getty Images
  • The most common types of painkillers include over-the-counter drugs like ibuprofen, aspirin, acetaminophen, and naproxen.
  • In more severe cases of pain, your doctor may also prescribe opioids like morphine, codeine, and oxycodone.
  • It’s important to always follow directions closely when taking painkillers, whether OTC or prescription, as they can both have serious side effects.
  • Visit Insider’s Health Reference library for more advice.

It’s common to reach for an over-the-counter painkiller if you’re experiencing headaches, muscle soreness, joint pain, or even period cramps. The popular brand-name options — like Advil, Tylenol, or Aleve — can all be effective at relieving this pain.

However, some painkillers may be a better fit for you than others, and all of them have specific instructions that must be followed carefully in order to be taken safely. In more severe cases of pain, like after surgeries or injuries, your doctor may also prescribe a prescription painkiller.

Here’s everything you need to know about the different types of over-the-counter and prescription painkillers and how to use each safely and effectively.

Ibuprofen

Common brand names: Advil and Motrin

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting the cyclooxygenase enzyme (COX enzyme). This prevents prostaglandins from forming.

Prostaglandins are responsible for inflammatory reactions in the body, says Donna-Ann Thomas, MD, anesthesiologist and division chief of pain medicine at Yale Medicine. By blocking prostaglandins, ibuprofen reduces inflammation and the pain that comes along with it.

Dosing: The appropriate dose for adults is 400 milligrams every four to six hours, Thomas says. The medication can be taken for seven to 10 days. If you feel like you need to take the medication beyond this time period, you should contact your doctor and only take the medication long term under their supervision, since taking ibuprofen long-term can cause dangerous side effects like peptic ulcers or kidney failure.

Aspirin

Common brand names: Bayer and Ecotrin

Similar to ibuprofen, aspirin is also a NSAID that inhibits the COX enzyme and prevents inflammatory prostaglandins from forming. This reduces inflammation and pain.

Dosing: The appropriate dose for adults is 325 milligrams or 650 milligrams every four hours (one or two regular strength pills) or 500 milligrams (extra strength dosage) every six hours, Thomas says. Like ibuprofen, aspirin can be taken safely on a short term basis for seven to 10 days. If you need to take it for longer, contact your doctor, since long-term use can result in harmful side effects such as peptic ulcers or kidney failure, similar to ibuprofen. However, your risk of peptic ulcers is higher with aspirin.

Naproxen

Common brand name: Aleve

Naproxen is also in the NSAID class and works the same way as ibuprofen and aspirin, by inhibiting the COX enzyme and preventing the formation of prostaglandins, reducing inflammation and pain.

Dosing: The appropriate dose for adults is 220 milligrams every eight to 12 hours, Thomas says. Just like ibuprofen and aspirin, naproxen should only be taken short term for seven to 10 days unless you are under supervision of a doctor and instructed to do so. Since it is also an NSAID it comes with the same long term side effect risks as aspirin and ibuprofen:peptic ulcers and kidney failure.

Acetaminophen

Common brand name: Tylenol

Acetaminophen, also sometimes referred to as paracetamol, works differently from the NSAIDs.

Thomas says acetaminophen is a central acting drug, meaning it works centrally in the brain towards pain pathways. Though the exact mechanism of how acetaminophen works is unclear to researchers, it may work by inhibiting the COX pathway in the central nervous system.

Dosing: The appropriate dose for adults is 325 milligrams (regular strength) or 500 milligrams (extra strength) every four to six hours, Thomas says, and you should not exceed 3000 milligrams in a day. Acetaminophen can be taken safely for seven to 10 days without supervision of a doctor. If you need to take it for longer, contact your doctor. Liver damage is the main risk with acetaminophen.

Prescription painkillers

When it comes to prescription painkillers, opioids are most common. Natalie Neumann, MD, a Yale Medicine toxicologist in the department of emergency medicine, says that some commonly prescribed opioids are:

  • Codeine
  • Hydrocodone
  • Morphine
  • Oxycodone

These drugs work by a completely different mechanism than over-the-counter pain medications. Throughout the body, there are endogenous opioid receptors. Thomas says opioids interact with these receptors in a way that results in analgesia, or pain relief.

“The long and the short of this is that endogenous opioid receptors are simply a group of receptors in the human body. Generally, when an agent binds to this group of receptors, pain is diminished,” says Neumann.

Neumann says opioids are most frequently prescribed to treat pain from serious injuries or fractures, pain after surgeries or operations, and chronic pain for patients with cancer.

Dosing: The duration of treatment and dosage of opioids varies from person to person, depending on the condition. Thomas says the main risks are addiction and overdose, and today, opioids are cautiously prescribed due to their highly addictive nature.

Insider’s takeaway

All pain medications, whether over-the-counter or prescription, should be used with caution. If you will be taking an OTC pain medication, be sure to follow the instructions on the label and contact your doctor if you need to take it longer than seven to 10 days. If you’re taking prescription painkillers, be sure to use them only as prescribed by your doctor.

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