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Even mild chronic pain -- whether from arthritis, migraines, or another condition -- can be debilitating. So it makes sense to take a pain reliever to make the hurt go away. But when you walk down the aisle of your local drug store, there are many pain pills to choose from. How do you know which pain pill to choose? And just what is the difference between aspirin, acetaminophen, and ibuprofen?

Aspirin and ibuprofen belong to a large class of drugs known as nonsteroidal anti-inflammatory drugs, commonly called NSAIDs. NSAIDs and acetaminophen can block pain and reduce fever. Together, they make up the most widely used group of drugs for treating pain conditions. Here's information you can use in working with your doctor to find out if these pain pills are right for you.

How Do Anti-inflammatories, or NSAIDs, Differ From Acetaminophen?

The primary difference between NSAIDs and acetaminophen (Actamin, Pandadol, Tylenol) lies in the way each relieves pain. Acetaminophen works primarily in the brain to block pain messages and seems to influence the parts of the brain that help reduce fever. That means it can help relieve headaches and minor pains. But it's not as effective against pain associated with inflammation.

Inflammation is a common feature of many chronic conditions as well as injuries. NSAIDs reduce the level of  certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain.

What Are Some Examples of NSAIDs?

You are probably already familiar with several types of NSAIDs. For instance aspirin is a widely used pain pill and at one time, aspirin was the only NSAID available without a prescription. Other NSAIDs, such as ibuprofen or naproxen sodium, began as prescription drugs. Now they are sold, usually at a lower dose, as over-the-counter pain pills.

Other examples of NSAIDs include:

  • diclofenac (Cambia, Cataflam, Voltaren)
  • etodolac (Lodine)
  • fenoprofen (Nalfon)
  • flurbiprofen (Ansaid)
  • naproxen (Anaprox, Naprosyn)
  • oxaprozin (Daypro)

Some pain pills, such as Excedrin Migraine, combine an NSAID -- in this case aspirin – with acetaminophen.

Another kind of NSAID -- available only by prescription – is known as a COX-2 inhibitor. These medicines provide pain relief like other NSAIDs, but they are less likely to cause stomach problems. The only COX-2 inhibitor available in the U.S. is celecoxib (Celebrex).

How Do I Know Which NSAID Will Work for My Chronic Pain?

The effectiveness of any particular pain medication varies from person to person. So it may be necessary to try several different medicines at various dosages. Side effects -- and their severity -- vary from person to person. You may not be able to take a particular NSAID because your body can't tolerate it. At the same time, your neighbor may take it and have no problem at all.

Whether you should take an over-the-counter pain reliever or a prescription-strength NSAID also varies from person to person. Remember, over-the counter painkillers are still medicines. They may be cheaper than prescription medicines and you don't need a doctor's prescription to buy them, but they can still have major effects on you. That's especially true if you are going to take a pain pill long term for chronic-pain. If you need pain medicine for more than 10 days, talk to your doctor to see which one is right for you.

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