I find aspirin by far the best non-opioid painkiller. In fact in terms of REMOVING the pain, it’s better than opioids. There is no compairson with stuff like paracetamol, ibuprofen, diclofenac etc.
However while I understand it works differently to paracetamol it’s supposed to work basically the same as ibuprofen and diclofenac. So as my title says: Are different NSAIDS “supposed” to be different in their painkilling properties and if so, why?
I don’t know, but I do know that for me, aspirin is worse for blood-thinning than ibuprofen or naproxen, so I generally use one or both of the latter two. May be TMI, but my periods are messy enough without the added bleeding aspirin seems to facilitate.
I can’t tell you why, but it is quite obvious that different pain killers work on some pain and not on others. I take morphine everyday for chronic pain, but I noticed that when I had a toothache the morphine did absolutely nothing to full the pain in my tooth. Tylenol took care of the tooth pain, but does zero for my chronic back pain. I have always wondered why this was. Does theTylenol work on different pain receptors than the morphine?
Acetaminophen (aka paracetamol or Tylenol) isn’t an NSAID. 
Am I the only person for whom acetaminophen is sedating? I take Tylenol or equivalent, I’m taking a nap whether I want to or not.
Aspirin is an inhibitor of cyclooxygenase I and II. COXII is responsible for making prostaglandins, which are the molecules responsible for pain. COXI helps maintain the stomach lining, among other things, which is why aspirin sometimes causes stomach problems. The so-called “superaspirins” of a few years ago were specific COXII inhibitors, but they’re off the market now due to other side effects, IIRC. I was under the impression that other NSAIDs work via the same mechanism, but I’m not sure about that. It’s not really my area of expertise.
You could Google each one or read the package.
Effects are variable for different people. I, for example, find acetaminophen does exactly nothing for pain of any kind. Aspirin is OK but ibuprofen works the best. But that’s just me. I believe Celebrex and other COX II inhibitors are still on the market but with strong warnings about side effects. I used Celebrex for a while but found it didn’t do any more for me than ibuprofen.
celebrex makes my feet and lower legs swell up until they are roughly the same diameter as my calves. naproxen is as effective as blue M&Ms without the benefit of chocolate. Ibuprofin works fine on me. No idea why, but back in 2003 I went to a civilian OB/GYN because it was faster than struggling with military med for an appointment. I have absolutely no idea why but she was willing to give me a prescription for naproxen, but argued with me when I asked for scrip strength motrins [800 mg] because I knew they worked well for menstrual pain. Crap on a stick, it wasn’t like I was asking for codeine or some other opioid.:dubious:
There’s no difference in NSAID effectiveness between one type or class, as a whole. Many patients seem to get more benefit from one NSAID vs. another, but overall those differences are not reproduceable for people in general.
So when prescribing, I’ll try folks on different ones, and see if one works better than another for them, but it’s unpredictable which they will or won’t respond to.
Have trials been done with patients that do claim one type is better than another to see if they can tell the difference when it’s blinded? I am interested in knowing if my preference for aspirin is an illusion or not.
Most NSAIDs don’t have the anti-coagulant (anti-platelet) effects that aspirin does, from what I can tell.
That makes me wonder - is it plausible that Asprin has another pain killer mechanism as well as the COX stuff?
No, it just works differently than the other COX inhibitors.
I think all NSAIDS do, to some (smaller) extent, because they are COX inhibitors. Wikipedia:
Mm, you may have something there. Aspirin may have a stronger effect, perhaps? That’d be interesting to find out, since aspirin seems to always be the one touted as the “blood thinner” of the group.
Ibuprofen and other NSAIDs are reversible thromboxane inhibitors. Once the drug is cleared by the kidney, the effect goes away, and platelets return to normal in anywhere from 4 to 12 hours.
Aspirin’s effects, on the other hand, are irreversible on the platelet. That platelet will stay less ‘sticky’ until it is destroyed and replaced. Given usual platelet turnover, that means the effects of a single tiny dose of aspirin (81 mg) will persist for 48-72 hours.