# Which common OTC analgesic is better in the long run? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [February 6, 2020, 4:40pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546 "2020-02-06T16:40:49Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![dolphinboy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dolphinboy/32/330_2.png) [@dolphinboy](https://boards.straightdope.com/u/dolphinboy)\ **Post date:** [February 6, 2020, 4:40pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/1 "2020-02-06T16:40:49Z")
You are not my doctor, I am not your patient… and I will ask my PCP the next time I happen to see him. I bowl league every Thursday for about 3 hours (we’re slow bowlers) and practice bowling for at least an hour 3-4 times a week. I also do moderate exercise, like hiking or walking daily for at least an hour. I try to stay in reasonable shape and use a treadmill when the weather is unsuitable for being outside. I should also mention that I’m also 65 years old with no medical issues except I take a statin for my cholesterol. I’ve been taking a statin for over 30 years with no ill effects that I am aware of. A few times a week my legs, back muscles or arms feel sore and I take an OTC analgesic to knock down the pain. In the past, I have taken Ibuprofin, Asprin, Acetphenomen and Naproxen Sodium, and they all seem to work, but I usually take Naproxen Sodium (1-3 220 mg tabs) because it works a little better and faster than the others. My question is does it matter which one I take? Should I rotate what I take since they all basically work or stick with one if it works better for me than the others? I know there are problems with taking Acetphenomen in high doses over a long period of time, but I’m not aware of any issues with the others. It’s not like I take them every day, or take 1000 mg. It’s for routine muscle pain. I don’t want to poison my liver if I can avoid it by taking the right analgesic. ---
**Author:** ![RitterSport](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rittersport/32/6326_2.png) [@RitterSport](https://boards.straightdope.com/u/RitterSport)\ **Post date:** [February 6, 2020, 5:11pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/2 "2020-02-06T17:11:03Z")
> [@dolphinboy](#): > > You are not my doctor, I am not your patient… and I will ask my PCP the next time I happen to see him. > > I bowl league every Thursday for about 3 hours (we’re slow bowlers) and practice bowling for at least an hour 3-4 times a week. I also do moderate exercise, like hiking or walking daily for at least an hour. I try to stay in reasonable shape and use a treadmill when the weather is unsuitable for being outside. I should also mention that I’m also 65 years old with no medical issues except I take a statin for my cholesterol. I’ve been taking a statin for over 30 years with no ill effects that I am aware of. > > A few times a week my legs, back muscles or arms feel sore and I take an OTC analgesic to knock down the pain. In the past, I have taken Ibuprofin, Asprin, Acetphenomen and Naproxen Sodium, and they all seem to work, but I usually take Naproxen Sodium (1-3 220 mg tabs) because it works a little better and faster than the others. > > My question is does it matter which one I take? Should I rotate what I take since they all basically work or stick with one if it works better for me than the others? I know there are problems with taking Acetphenomen in high doses over a long period of time, but I’m not aware of any issues with the others. It’s not like I take them every day, or take 1000 mg. It’s for routine muscle pain. I don’t want to poison my liver if I can avoid it by taking the right analgesic. My non-doctor understanding is that NSAIDS like Ibuprofin, aspirin, and Naproxen Sodium can be tough on your stomach and stomach lining, but not so hard on the liver. I think they can also lead to bleeding (I’m always told not to take them for days before any surgery). Acetaminophen is fine at low doses but just a little above the maximum dose can cause liver damage. I further understand that your liver is in more danger if you’re drinking alcohol while taking acetaminophen. Does acetaminophen even work for you? I remember seeing a study that it’s somewhat effective for headaches but does almost nothing for muscle or back pain. For me, if I have a headache, acetaminophen can turn it from a bad headache to a dull headache, but that’s it. Ibu and aspirin get rid of it. I’ve never taken Aleve (the other one you mention). ETA: Here’s the study that shows that Tylenol is no better for lower back pain than a placebo: [Paracetamol for low back pain - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353046/) ---
**Author:** ![Willowcat](https://avatars.discourse-cdn.com/v4/letter/w/6f9a4e/32.png) [@Willowcat](https://boards.straightdope.com/u/Willowcat)\ **Post date:** [February 6, 2020, 5:11pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/3 "2020-02-06T17:11:17Z")
Topical CBD THC 1:1 lotion works well for me, if you are in a legal state. I’ve also had good results with topical diclofenac, but you need a script in the US. I try to avoid meds that lead to stomach issues unless I really need the pain relief. ---
**Author:** ![Annie-Xmas](https://avatars.discourse-cdn.com/v4/letter/a/ecc23a/32.png) [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)\ **Post date:** [February 6, 2020, 5:16pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/4 "2020-02-06T17:16:23Z")
When I snapped off my wrist bone and refused to take prescription pain killers, the doctore told me to take Aleve and Tylenol together. Worked for me! ---
**Author:** ![MindsEye\_Watering](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mindseye_watering/32/3619_2.png) [@MindsEye\_Watering](https://boards.straightdope.com/u/MindsEye_Watering)\ **Post date:** [February 6, 2020, 5:18pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/5 "2020-02-06T17:18:18Z")
I usually take ibuprofen, but when I need a little extra oomph, I’ll add some Tylenol to that. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [February 6, 2020, 5:34pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/6 "2020-02-06T17:34:51Z")
It’s totally anecdotal, but in my last job, I implemented and supported a pharmacy system for one of the country’s premier occupational health care companies (which means a lot of strains, sprains and overuse injuries), and from what I can tell (I often had reason to look at the prescribed medication in aggregate (for restocking/ordering)) , the doctors pretty much NEVER prescribed acetaminophen, but prescribed a metric shit ton of naproxen, and a lesser amount of ibuprofen. ---
**Author:** ![dolphinboy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dolphinboy/32/330_2.png) [@dolphinboy](https://boards.straightdope.com/u/dolphinboy)\ **Post date:** [February 6, 2020, 6:05pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/7 "2020-02-06T18:05:59Z")
Calling QtM… ---
**Author:** ![Alpha\_Twit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alpha_twit/32/265_2.png) [@Alpha\_Twit](https://boards.straightdope.com/u/Alpha_Twit)\ **Post date:** [February 6, 2020, 7:01pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/8 "2020-02-06T19:01:07Z")
My go-to OTC is Bayer “Back and Body” (aspirin with caffeine). I’ve reported occasional, heavy use of this to my doctor at levels of nearly twice the suggested dose for a month or more at a time. Her reply was amazement that I still had a stomach left but that as long as I didn’t have stomach problems/pain/unusual bleeding then there’s no real issue. ---
**Author:** ![gnoitall](https://avatars.discourse-cdn.com/v4/letter/g/bb73d2/32.png) [@gnoitall](https://boards.straightdope.com/u/gnoitall)\ **Post date:** [February 6, 2020, 7:26pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/9 "2020-02-06T19:26:15Z")
I’m curious if OP has an articulatable definition of “better long-term”. Less likely to be addictive? Less likely to cause side effects? Less likely to be toxic? More effective? Cheaper? There are multiple criteria, and OTC analgesics check different boxes in different dimensions. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 6, 2020, 7:59pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/10 "2020-02-06T19:59:22Z")
As far as NSAIDs (ibuprofen, naproxen, mobic, indocin, aspirin, etc) go, there’s no good evidence that any one of them is superior for pain relief. Now, many individuals state they respond to ibuprofen but not naproxen, or indocin but not mobic, or the reverse. But on average, no one NSAID appears superior for pain relief. And thus far tylenol (apap, acetaminophen) seems to about equally efficacious in relieving pain as the NSAIDs. Now, NSAIDs can reduce inflammation whereas tylenol cannot, and many think that by popping a dose or three of their fave NSAID, they’re reducing inflammation. But they’re not. It takes a few weeks of regularly scheduled dosing (3-4 x a day for ibuprofen, 2 x a day for naproxen) to reduce inflammation. Chronic NSAID use can cause stomach ulcers, promote bleeding in the GI tract, brain and elsewhere, and can impair kidney function, even when taken in prescribed doses. Chronic tylenol use in prescribed/recommended doses tends to not cause problems unless there is underlying liver disease, especially when combined with alcohol use. Up to 3 grams of tylenol a day is considered safe for folks with a healthy liver. Many folks tolerate 4 grams a day just fine too. ---
**Author:** ![RitterSport](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rittersport/32/6326_2.png) [@RitterSport](https://boards.straightdope.com/u/RitterSport)\ **Post date:** [February 6, 2020, 8:10pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/11 "2020-02-06T20:10:17Z")
**QtM** , just curious about what you think about the NIH study that shows that Tylenol is no more effective than a placebo for lower back pain? I’m not really qualified to read those studies. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [February 6, 2020, 8:20pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/12 "2020-02-06T20:20:51Z")
Anyone use a heat rub type product you rub on the skin for the OP’s problem? ---
**Author:** ![jtur88](https://avatars.discourse-cdn.com/v4/letter/j/e9c0ed/32.png) [@jtur88](https://boards.straightdope.com/u/jtur88)\ **Post date:** [February 7, 2020, 3:25am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/13 "2020-02-07T03:25:16Z")
I go with Ibuprofin, but tooth pain is the only thing i can remember using it for. ---
**Author:** ![digs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/digs/32/14889_2.png) [@digs](https://boards.straightdope.com/u/digs)\ **Post date:** [February 7, 2020, 3:31am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/14 "2020-02-07T03:31:15Z")
I like the fact that ibuprofen is an anti-inflammatory as well as a pain-killer. And when I had shoulder problems for a year, I took a double dose every day with no long-term problems. ---
**Author:** ![dolphinboy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dolphinboy/32/330_2.png) [@dolphinboy](https://boards.straightdope.com/u/dolphinboy)\ **Post date:** [February 7, 2020, 4:57am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/15 "2020-02-07T04:57:47Z")
Thanks, QtM. While I haven’t noticed any stomach problems with Naproxen, it sounds like since I don’t drink and I don’t have liver problems Tylenol would probably be better for me “in the long run”. What I mean by “in the long run” is that if I were to take 4-6 tablets a week for months on end what is less likely to cause health issues, whether liver, stomach or other issues just from taking the analgesic? I’m not talking about high doses here, just long term use for relatively minor muscle pain. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 7, 2020, 1:15pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/16 "2020-02-07T13:15:19Z")
> [@RitterSport](#): > > **QtM** , just curious about what you think about the NIH study that shows that Tylenol is no more effective than a placebo for lower back pain? I’m not really qualified to read those studies. which study is that? Link? ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 7, 2020, 1:16pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/17 "2020-02-07T13:16:19Z")
> [@dolphinboy](#): > > Thanks, QtM. While I haven’t noticed any stomach problems with Naproxen, it sounds like since I don’t drink and I don’t have liver problems Tylenol would probably be better for me “in the long run”. What I mean by “in the long run” is that if I were to take 4-6 tablets a week for months on end what is less likely to cause health issues, whether liver, stomach or other issues just from taking the analgesic? I’m not talking about high doses here, just long term use for relatively minor muscle pain. Chronic use of up to 3 grams of tylenol a day is considered safe for folks with a healthy liver. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 7, 2020, 1:17pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/18 "2020-02-07T13:17:27Z")
> [@digs](#): > > I like the fact that ibuprofen is an anti-inflammatory as well as a pain-killer. And when I had shoulder problems for a year, I took a double dose every day with no long-term problems. As I noted earlier, a few doses here and there won’t have an anti-inflammatory effect. Research tends to indicate that you need over 2 grams of ibuprofen daily for 2-3 weeks before getting significant reduction of inflammation. Which is also a dosage where risk of side effects/complications is increased. ---
**Author:** ![RitterSport](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rittersport/32/6326_2.png) [@RitterSport](https://boards.straightdope.com/u/RitterSport)\ **Post date:** [February 7, 2020, 1:19pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/19 "2020-02-07T13:19:15Z")
> [@Qadgop\_the\_Mercotan](#): > > which study is that? Link? Here you go: > **[Paracetamol for low back pain](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353046/)** > > Analgesic medication is the most frequently prescribed treatment for low back pain (LBP), of which paracetamol (acetaminophen) is recommended as the first choice medication. However, there is uncertainty about the efficacy of paracetamol for LBP.To... It’s specifically about lower back pain, not general muscular pain, though. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [February 7, 2020, 1:34pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/20 "2020-02-07T13:34:33Z")
> [@RitterSport](#): > > Here you go: > > [Paracetamol for low back pain - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353046/) > > It’s specifically about lower back pain, not general muscular pain, though. It’s not done by NIH, it’s just referenced at their website. It’s also a meta-analysis of other studies, not an original study. Meta-analyses can provide valuable data, and they’re useful tools. But they’re not automatically definitive. It compares acetaminophen with placebo; we can’t contrast it against NSAIDs or narcotics or other agents. It looks at a pain restricted to one general location. It concludes acetaminophen performs as well as placebo for acute low back pain; their results are inconclusive for whether it gives benefit for chronic back pain. I’m not surprised by the result; low back pain is actually a very complex issue with lots of real pain from various possible sources and tons of supratentorial overlay. But it doesn’t really say all that much about acetaminophen’s efficacy as a pain reliever in general. [Next page](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546.md?page=2)