When it comes to pain relief, most people turn first to their medicine cabinet. But most people also have more than one pain reliever to choose from. There are so many options—Advil, Tylenol, Excedrin, good old aspirin and all sorts of generic and prescription alternatives.

The question is: which bottle should you reach for when your back pain flares up? That’s not always an easy question to answer. As with all medicines, every type of pain reliever has benefits and risks. Plus, specific types of pain may respond better to one kind of medication than to another kind. And everyone reacts differently to different meds. What takes away your pain might not work for someone else.

So, how do you choose? First, you can review the pros and cons of each.

Over-The-Counter Pain Medicines

Over-the-counter (OTC) medications are good for many types of pain. There are basically two types of OTC medicines:

1. Acetaminophen (common brand: Tylenol).

PROS: Acetaminophen is a non-aspirin pain reliever, so it may be easier on your stomach than aspirin. It is also safer for children. It can be used to lower a fever and soothe headaches and other common aches and pains, including back pain.

CONS: Acetaminophen does not reduce swelling (inflammation). It can be harmful to the liver if you take more than the recommended dose.

2. Non-steroidal anti-inflammatory drugs (NSAIDs).

PROS: NSAIDs, which include aspirin, naproxen (common brand: Aleve) and ibuprofen (common brand: Advil), relieve pain and reduce inflammation caused by injury, arthritis, or fever. NSAIDs work by reducing the production of hormone-like substances that cause pain.

CONS: They may cause gastrointestinal bleeding. They may also be harmful if you have high blood pressure or kidney disease. And they should NEVER be given to children. Aspirin has been associated with a disease called Reye’s syndrome in children.

Prescription Pain Medicines

When OTC medicines fail, your doctor may have you try prescription painkillers:

1. COX-2 inhibitors.

PROS: This class of drugs blocks an inflammation-promoting substance called COX-2. They were initially believed to work as well as traditional NSAIDs, but with fewer stomach problems.

CONS: Numerous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and benefits of the COX-2s. COX-2 drugs such as Vioxx and Celebrex were actually taken off the market because of these risks.

2. Narcotic painkillers.

PROS: Commonly used opioids, which include oxycodone (OxyContin), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), and diphenoxylate (Lomotil), are very strong and powerful painkillers.

CONS: Narcotic drug abuse and addiction are a real possibility. An estimated 20 percent of people in the United States have used prescription drugs for nonmedical reasons. The problem is serious and it is growing. The availability of drugs is probably one reason. Doctors are prescribing more drugs for more health problems than ever before. Online pharmacies make it easy to get prescription drugs without a prescription, even for youngsters.

Other Considerations

When shopping for pain meds, there are other things to consider as well. Such as:

Buffered. A buffered pain reliever contains an antacid to reduce acidity in the stomach. But it’s debatable whether buffered products actually help.
Combination formula. Some products contain two or more active ingredients. Caffeine is sometimes used as an active ingredient in addition to other pain relievers (such as Excedrin). Studies show that the addition of caffeine to aspirin or acetaminophen improves pain relief.
Timed-release. Also called extended-release or sustained-release, these products dissolve slowly. They prolong the effect of the medication by maintaining a sustained level of the active ingredient in your blood. They are better for long-lasting relief, but not as good if the pain comes on quickly and severely.
Extra-strength. These products contain more active ingredient than regular-strength products. For example, an extra-strength Tylenol has 500 milligrams of acetaminophen, compared with 325 milligrams in the regular-strength version. Extra-strength formulas may be more convenient when you need more than one regular-strength dose to relieve your symptoms. But be careful. Keep track of dosages so you don’t overdose. Also make sure other meds you take don’t contain the same active ingredient, such as cold medicines, so you don’t accidentally overdose.
Active ingredient. This is the actual chemical or chemicals that relieve your symptoms. Note the amount of active ingredient in each dose — usually expressed in milligrams (mg). Typically, you can choose among several pain medications that have the same active ingredient and dose. This is where generics can save you money. Brand-name pain relievers, such as Tylenol, aren’t any better than their generic equivalents, such as your local drugstore brand acetaminophen. So you can choose the best price or for a preferred method of delivery—capsule instead of tablet, for example.

Drugs Don’t Heal

The smartest way to choose a pain reliever is to go over your choices with your doctor. The doctor will know your medical history, the other meds your on and other factors that can help you pick the right pain reliever for your condition.

But remember, drugs don’t fix the problem, they only mask the pain. Pain relief medications should only be used temporarily. And they should be used in conjunction with all of the physical, emotional and spiritual aspects that promote healing.

Still not comfortable making up your mind?

If you are still concerned, there are several natural alternatives to choose from. The first is the homeopathic category, derived from botanicals that are then put through a process of dilution and succession to derive their potency.

Here are just two examples of homeopathies: bryonia, from the bryony plant, and Rhus toxicodendron, from the Poison Ivy vine. Both reduce pain and inflammation.

Then there are dietary supplements, vitamins and minerals, other botanicals and a little known, unique and very effective class of supplements called proteolytic systemic enzymes.

Here are just some of the many supplements derived from plants that help with pain and inflammation: bromelain from pineapple, papain from papaya, ginger, turmeric, boswellia and devil’s claw.

Homeopathic remedies and supplements have their pros and cons too.

PROS: Both homeopathic remedies and supplements work synergistically with the body to both help the body with the symptoms of a condition and help the body heal. They have minimal side effects, are abundantly available and are inexpensive.

CONS: Neither homeopathic remedies and supplements are as powerful or as potent as pharmaceutical drugs. That’s one reason why supplements can be used long term to maintain health and promote well-being. There are not a lot of scientific data about their effectiveness.

What to do…

I hope you have learned something about the different considerations when choosing a pain medication. The hope is that you stay safe and remain healthy by eating right and exercising over the long haul and not letting the daily grind run you down.

If you find yourself in dire straits about what to do about pain, it could help to think BOTH short term–using drugs to help take the edge off—and long term–taking daily supplements for health and healing.

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