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Pain Relief
Your guide to over-the-counter products

Unfortunately, for most of us pain can be a fact of life. Whether it is a headache, muscle aches and strains, or arthritis, there is relief available. That’s where over-the-counter (OTC) pain relievers come in. Before you make a selection, however, you should be well informed.

Are you baffled by the amount of choices staring at you from the pharmacy shelves? Don’t be! There are three OTC pain relief drugs available in Canada today. These are ASA (acetylsalicylic acid), acetaminophen, and ibuprofen. Sometimes these are combined with other drugs for relief of other symptoms, but we’ll get to that later.

ASA (Acetylsalicylic Acid)

ASA was originally brought to market as Bayer Aspirin™. A similar chemical has been known for centuries. Roman soldiers used willow bark, which contains salicylates, to relieve their pain symptoms. Today ASA is available in many strengths and in both uncoated and enteric coated tablets. The uncoated tablets dissolve quickly and are used for speedy relief of minor pains. The enteric coated tablets make ASA easier on the stomach. They are used for arthritis sufferers who take ASA regularly. Your doctor may also recommend enteric coated ASA to prevent heart attacks.

Before taking ASA, you should check with your pharmacist or doctor if any of the following apply to you.

• You have a history of peptic ulcer disease (ulcers in the stomach or beginning of the intestines).
• You have reduced kidney function or liver disease.
• You will be having elective surgery in the near future.
• You have asthma or other lung disease.
• You are taking prescription drugs (especially blood thinners such as warfarin).
• You are allergic to ASA or NSAIDs (non-steroidal anti-inflammatory drugs)

ASA is not recommended for children or young adults because of its possible link to Reye’s Syndrome, which can be a very serious condition. Pregnant women should only use ASA on the advice of their doctor. ASA should be taken with food to reduce the chance of stomach upset.

Acetaminophen

Acetaminophen was first marketed as Tylenol™, and is the most commonly used pain reliever. It can be used by all ages, does not react badly with most other drugs, and is the easiest on the stomach of all three OTC pain relievers. It works well for pain and fever, but does not affect inflammation. Some people will still use it to treat arthritis, because it does treat the pain of the disease. Acetaminophen comes in many forms and brands, including liquid for a child’s pain and fever, regular tablets and caplets, as well as a timed release tablet.

Before you choose acetaminophen, check with your pharmacist or doctor if you have liver disease, are pregnant, or are taking prescription drugs.

Ibuprofen

Ibuprofen became an OTC medication in the late 1980s. Today it is available as Advil™ or Motrin™ and as generic brands. Ibuprofen is effective for pain and inflammation, and has been marketed recently as a liquid to treat a child’s fever. Many dentists will recommend this drug because it works well for dental pain. Ibuprofen is similar to ASA, so many of ASA’s precautions (see above) apply to ibuprofen. Ibuprofen should always be taken with food. Check with your pharmacist or doctor before you take this medication.

Combination Products

Codeine is available without a prescription in an eight-milligram strength, as long as the tablet contains two non-narcotic ingredients. These are often caffeine added to either ASA or acetaminophen. Pain relievers containing codeine are only available directly from your pharmacist. Codeine is a drug that has abuse potential, and large doses of these products are damaging to the liver or kidneys. Codeine can also cause drowsiness and constipation (trouble moving the bowels). For these reasons, your pharmacist will want to document the sale of these products so the health and safety of the pain sufferer can be ensured.

Muscle relaxants are also combined with pain relievers to treat aches and strains and stiff muscles. Methocarbamol and chlorzoxazone are the two most common in Canada. These products should be taken with food and can cause drowsiness. Examples of these products include Robaxacet™, Robaxisal™, Parafon Forte™, and Tylenol™ Aches and Strains.

Rubs

Rubs can be an effective way to treat sore muscles or arthritis. They act as counter-irritants. This means that the ingredient in the rub causes a very mild irritation in the skin that makes the body forget about the pain. You can choose a rub with a warming or cooling effect, depending on your preference. Most rubs will have a rapid effect, except for the ones containing capsaicin. Capsaicin has an effect that builds over time and must be used regularly. When using a rub, you should not apply heat (including baths or heating pads) or wraps to the affected area. This can result in burns.

The next time you are looking for pain relief, remember to ask your pharmacist. While there are few ingredients for pain relief on the market, there are many brands and different dosage forms on the pharmacy shelves. If these drugs prove ineffective for you, it is always important to visit your family doctor for prescription medication and, or, other care. With your pharmacist’s help, you can choose the one that is right for you.