Recently, while I was strolling through my local drug store, I came to a halt in the pain relief section. I had never really thought of it until then, but if I were a looking for a specific type of analgesic, I would be in the midst of a meltdown. Here were dozens of names for pain relief. The familiar (Advil, Excedrin, and Tylenol, just to name a few), the knock-off (personal favorite: Walproxen), and the bizarre (caffeine plus aspirin equals Anacin). To complicate matters, each brand had several permutations of itself. Why go with regular when you have the extra-strength, gel-capsuled, PM dose? Just the sight of it gave me a tension headache, for which I discovered that Excedrin had a specific formulation to treat.
Despite the variety, the litany of names represents only a few different active ingredients. You’ve probably heard of NSAIDs (non-steroidal anti-inflammatory drugs), which include aspirin and ibuprofen, and likely acetaminophen. But do you know exactly what each does to relieve pain? More importantly, what can’t they do?
Advil
Advil is the most well-known trade name for ibuprofen. Surprisingly, this ubiquitous and well-known product has only been available for over-the-counter purchase since 1984.
Ibuprofen is one of the many NSAIDs (aspirin and naproxen sodium are also NSAIDs) that work by preventing the generation of enzymes called cyclooxygenase (COX), responsible for the creation of a hormone called prostaglandin. Prostaglandins are responsible for stimulating the body’s inflammation and pain responses. By reducing the enzymes that create prostaglandins, NSAIDs help reduce those symptoms associated with inflammation (redness, swelling, and aching), which is why they are often used in sports injuries and arthritis.
Because it is a stable compound, ibuprofen is available in multiple forms, hence the gel-caps, solutions, etc., that you’ll see it in. Initially introduced as a hand-made, anti-arthritic medication, it was sold by prescription only. When the FDA cleared it for over-the-counter sales, Advil (as it was called in the U.S.) moved so fast that demand outstripped supply, and large-scale manufacturing kicked off. Today, all Advil facilities combined produce over 30 million tablets every day.
With that output, high levels of consumption exist in the U.S. So much so that, like many NSAIDs, ibuprofen has been linked to gastrointestinal bleeding and is especially bad in folks with irritable bowel syndrome (IBS). Due to a select number of people popping these pills like Mentos, the medical community tells people with a history of cardiac disease to be careful, as ibuprofen has been linked to cardiac infarction.
There are other ibuprofen brands out there, Motrin most likely being the biggest, but ultimately the differences are nil. Motrin has a higher dosage level than that of Advil, so practitioners generally advise taking fewer doses of Motrin only because the amount of ibuprofen present is greater.
Health Top Tips Nutrition Love Lifestyle Happiness Weight LossAleve
Aleve is a strong NSAID, intended to reduce pain and inflammation for everything from fevers to arthritis to dysmenorrheal (painful menstrual periods). Of all of the pain relieving products, this is the most recently approved for over-the-counter sale (1994).
Aleve is the trade name here in the states for naproxen sodium (so Walproxen is just the Walgreens version of Aleve). Naproxen works by inhibiting COX-1 and COX-2 enzymes, two proteins that are responsible for the body’s inflammatory process. If any of that sounds familiar, that’s because it works much like a prescription drug, Celebrex. And if it’s a surprise that it works like prescription, that’s because it’s prescription-only just about everywhere else. Canada only took it off the prescription-only list in July 2009. And even then, our neighbors to the north have restricted its use in some provinces. Most of the concerns revolve around the risk to people with existing heart conditions or hypertension as naproxen sodium can cause heart attacks, strokes, or major disruption in blood pressure.
Bayer
Aspirin is the grandfather of the pain relief section. Fittingly, Bayer, the original manufacturer of aspirin, is one of the old-timers of the pharmaceutical industry. As the first NSAID, it’s also the one with the most known benefits (helps to prevent heart attacks and strokes) as well as the best characterized side effects (gastric ulcers). Aspirin is acetylsalicylic acid, a compound originally derived from willow extract.
The active ingredient was first isolated in 1853 by a French chemist, Charles Gerhardt, but wasn’t until thirty-eight years later that Bayer introduced aspirin as a better pain reliever than other salicylic compounds. In a recurring theme, aspirin works by inhibiting COX-1 and -2 enzymes, helping to prevent the inflammatory processes of the body. It also is an anti-coagulant, preventing blood clots and their corresponding outcomes, e.g. heart attacks and strokes, which is why its use has skyrocketed recently.
Unfortunately, aspirin does have some significant drawbacks. It’s the most likely of all the pain relievers on this list to irritate ulcers or cause gastric bleeding. It also isn’t recommended for children to due a rare but serious side effect: Reye’s syndrome. Using aspirin to treat a viral illness in children increases the risk of developing the syndrome, which can cause a cascade of symptoms, ultimately affecting the brain and liver. As such, aspirin is a big no-no for kids when they have a viral illness.
Tylenol
Tylenol, whose main ingredient, acetaminophen (known as paracetamol internationally) is a coal tar byproduct. It works by inhibiting particular inflammatory molecules (like the COX enzymes described above) and by restricting the ability of pain receptors to accept molecules necessary in transferring the pain signal through the body. However, because of acetaminophen works on pain receptors, it is not nearly as effective in reducing swelling as NSAIDs.
Acetaminophen was first introduced as a pain relieving, fever-reducing agent back in 1886. After several iterations, the product was approved in the United States in 1953, but Tylenol didn’t come along until two years later. Given the risks that children face in taking other pain relievers (aspirin being the biggest one), it became a huge boon for the product to be much better tolerated in all ages compared to its alternatives. However, that’s not without the caveat that overuse can cause liver damage, especially if combined with alcohol.
The Wild Card
Excedrin is made up of aspirin, acetaminophen, and caffeine. What’s the deal with it being caffeinated? It appears that caffeine makes an analgesic more effective in combating headaches. It does this by speeding up the rate and increasing the amount of the pain reliever absorbed by the body. So, for bad headaches, Excedrin is the choice of drugs. Alternatively, you could take acetaminophen or an NSAID with a cup of coffee.
Of course, I knew little of this information while shopping in the drug aisle. Choosing the right pill for specific symptoms and avoiding others in certain situations is certainly more important than what flavors of chewable tablets were available, but we have so many options when walking into a pharmacy and many, including myself, don’t bother to grasp the nuances. It can pay off to do a little research before purchasing a pill, however. Not all of them are effective for every ailment, and not all are as innocuous as they seem … even if they do come in cherry flavor.