# 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:** 7\ **Page:** 2
**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, 1:55pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/21 "2020-02-07T13:55:48Z")
> [@Qadgop\_the\_Mercotan](#): > > 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. Thanks! I definitely appreciate your insight on this. Anecdotally, it doesn’t work well for me. ---
**Author:** ![thorny\_locust](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thorny_locust/32/431_2.png) [@thorny\_locust](https://boards.straightdope.com/u/thorny_locust)\ **Post date:** [February 7, 2020, 8:31pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/22 "2020-02-07T20:31:39Z")
Anecdotally, acetaminophen doesn’t have any effect at all for me. (It made my mother feel ill.) Ibuprofen works best for me for headaches; aspirin for muscle aches. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [February 7, 2020, 8:46pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/23 "2020-02-07T20:46:00Z")
Probably not relevant to most folks here, but NSAIDS can cause grief for people with congestive heart failure and those with even mild kidney disease (especially in diabetics and especially if they’re also using ACEIs or ARBs, which many are). I don’t think their occasional use is anything to worry about, but daily or near-daily use by people with those problems/meds can be risky. On the other hand, even chronic use of acetaminophen is generally well tolerated. ---
**Author:** ![bordelond](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bordelond/32/150_2.png) [@bordelond](https://boards.straightdope.com/u/bordelond)\ **Post date:** [February 7, 2020, 9:08pm UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/24 "2020-02-07T21:08:19Z")
This thread sounds like the reverse of the conventional laymen’s wisdom from maybe 20 years ago, which was: a) acetaminophen damages the liver, and b) go nuts with ibuprofen – no side affects at any dose! So … in 2020 … 3000 mg/day of acetaminophen is safe for healthy patients … but a similar daily dosing of ibuprofen is probably contraindicated? Does an individual’s bodyweight have any bearing with the dosages here? ---
**Author:** ![carrps](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carrps/32/2957_2.png) [@carrps](https://boards.straightdope.com/u/carrps)\ **Post date:** [February 8, 2020, 12:39am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/25 "2020-02-08T00:39:10Z")
> [@RitterSport](#): > > 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/) This all reads true to me. Tylenol has never worked for me…for anything. For muscle aches I use ibuprofen. I get bad migraines. Absolutely _nothing_ OTC works for them (I use a triptan – specifically, a generic Imitrex). ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [February 8, 2020, 3:28am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/26 "2020-02-08T03:28:54Z")
> [@RitterSport](#): > > … > 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/) Gonna concur on this. 10 years back, I was scheduled for gallbladder surgery. I was also dealing with some fairly significant shoulder / knee pain issues that had me on NSAIDs pretty much daily. I had to stop them 10 days before, and just use Tylenol. Those 10 days really, really sucked. Honestly, for the OP: as long as you don’t have any stomach issues etc., I’d stick with whichever one works best. The amount you’re taking is unlikely to be a problem no matter what you use. I tended to think of them all as interchangeable, though for that knee / shoulder pain, the doctor prescribed diclofenac (a COX-2 inhbitor - somewhat similar to OTC NSAIDS) and wow, that stuff worked so very, very much better than ibuprofen. It’s harsher on the stomach, so it was actually combined with a stomach-protecting medication. ---
**Author:** ![Green\_Bean](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/green_bean/32/1760_2.png) [@Green\_Bean](https://boards.straightdope.com/u/Green_Bean)\ **Post date:** [February 8, 2020, 3:54am UTC](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546/27 "2020-02-08T03:54:04Z")
I take ibuprofen for headaches, general aches, and fortunately it works on my occasional migraines. I always thought of acetaminophen as being pretty useless. But I recently had 2 surgeries and a nasty infection as a result, and I was surprised that the docs gave me acetaminophen. (Well, some narcotics too, but only for a day or two as the pain wasn’t really that bad). The acetaminophen was extremely effective in easing the pain. When I tried ibuprofen for it, it did nothing. [Previous page](https://boards.straightdope.com/t/which-common-otc-analgesic-is-better-in-the-long-run/847546.md?page=1)