Medicines for Mild-to-Moderate Pain
By Peter Watson M.D. et Judy Watt-Watson M.D.
Acetaminophen (Tylenol) helps to relieve pain and fever but has no anti-inflammatory effect. It can be purchased off the shelf by itself or combined with small doses of codeine and caffeine. For example, acetaminophen 300 mg with 15 mg caffeine and 8 mg of codeine (Tylenol 1) can be purchased without a prescription but is “behind the counter.” The patient has to ask the pharmacist for this.
Acetaminophen is often combined with higher strengths (15 mg, 30 mg, or 60 mg) of codeine. Because codeine is a weak opioid medication, these higher strengths do require a prescription. All forms of acetaminophen with codeine are combined with caffeine except for Tylenol #4. This may be important if the drug is taken at bedtime.
The main caution with acetaminophen is its effect on the liver. Taking too much can cause liver damage, especially in people with liver disease or who drink a lot of alcohol. Doses more than 4000 mg a day should not be taken for long periods of time. In other words, a person should not take more than 13 tablets containing 300 mg each of acetaminophen during 24 hours.
Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain, reduce fever, and reduce inflammation as well. The most familiar are Aspirin, ibuprofen (Advil, Motrin, etc.) which are available without prescription. Another well-known NSAID is naproxen (Naprosyn) which requires a prescription in Canada.
The common side effects of NSAIDs are gastrointestinal. They may cause upper gastrointestinal problems such as nausea, vomiting, and constipation. Bleeding from the bowel may occur with prolonged use. These drugs should be avoided in people with peptic ulcer, kidney disease, heart failure, and asthma.
Both NSAIDS and acetaminophen have a ceiling effect which means taking more drug beyond a certain dose will not result in more pain relief. Acetaminophen and NSAIDs work in different ways, so they can be helpful when used together.