Which Painkiller for Which Pain? A Practical Guide to Choosing Safely

Walking into a pharmacy for pain relief can be confusing, with shelves of brands that often contain the same few ingredients. Choosing the right painkiller for your pain, and using it safely, makes a real difference.

Imagine a pounding toothache at night. You take paracetamol, then a combination cold remedy, then ibuprofen, without realising two of them contained paracetamol. A little knowledge would have given better relief, more safely.

The main over-the-counter painkillers

• Paracetamol (acetaminophen): for mild to moderate pain and fever; gentle on the stomach; dangerous in overdose
• Ibuprofen and other NSAIDs: for pain with inflammation, such as sprains, period pain, toothache and back pain; can irritate the stomach and affect the kidneys
• Aspirin: a painkiller and anti-inflammatory; not for children under 16 because of the risk of Reye’s syndrome
• Low-dose codeine combinations: available in some countries for short-term use only, because of dependence risk

Matching the painkiller to the pain

• Headache: paracetamol or ibuprofen; avoid using painkillers on more than about 10 to 15 days a month, which can cause medication-overuse headache
• Migraine: ibuprofen, aspirin or paracetamol taken early, sometimes with an anti-sickness medicine; triptans if prescribed
• Toothache: ibuprofen often works well; see a dentist
• Period pain: ibuprofen or another NSAID, started at the beginning of the pain
• Sprains and strains: ibuprofen for a few days, or topical gels
• Back pain: staying active is key; NSAIDs may help short term
• Fever in adults: paracetamol or ibuprofen

Daily limits and safety

Always check the dose on the packet. For healthy adults, paracetamol is typically limited to 4 grams in 24 hours, usually as two 500 mg tablets up to four times a day, with at least four hours between doses. Lower limits apply for people who weigh less than 50 kg, have liver problems or drink heavily.,Never take more than the stated maximum dose, even if pain is severe. Paracetamol overdose can cause serious liver damage, sometimes without early symptoms. If you think you have taken too much, seek urgent medical help even if you feel well.

Who should be careful with ibuprofen and other NSAIDs

• People with stomach ulcers or a history of stomach bleeding
• People with kidney disease, heart failure or uncontrolled high blood pressure
• People taking blood thinners, steroids or some antidepressants
• Some people with asthma, whose symptoms can be triggered
• Pregnant women, especially from 20 weeks, unless advised by a healthcare provider
• Older adults, who are more prone to side effects

Combining painkillers

Paracetamol and ibuprofen work in different ways and can be taken together or alternated by adults for short periods, if both are suitable for you. This can give better relief than either alone.,Never take two products containing the same active ingredient, such as two paracetamol-containing products, or ibuprofen with another NSAID such as naproxen or aspirin, unless a healthcare provider has advised it. Check the labels of cold and flu remedies, which often contain paracetamol.

Topical painkillers

Gels and creams containing NSAIDs such as ibuprofen or diclofenac can help with pain in joints near the skin surface, such as knees and hands, and in sprains. Less medicine reaches the bloodstream, so side effects are less likely. Wash your hands after use and avoid broken skin.

Children

• Use children’s formulations and dose by age or weight, as on the label
• Paracetamol and ibuprofen can both be used in children when needed
• Never give aspirin to children under 16 unless prescribed
• Use the measuring syringe provided

When to see a healthcare provider

• Pain lasting more than a few days without improvement
• Severe, sudden or unusual pain, such as the worst headache of your life
• Chest pain, which needs emergency help
• Pain with fever, weight loss or other worrying symptoms
• Needing painkillers most days
• Pain after an injury where you cannot move or bear weight

Frequently asked questions

Is branded ibuprofen better than generic?

No. Generic ibuprofen contains the same active ingredient and works just as well.

Can I drink alcohol with paracetamol?

Moderate drinking with normal doses is usually OK for healthy adults, but heavy drinking increases the risk of liver damage.

Which painkiller is safest in pregnancy?

Paracetamol is usually preferred. Always check with a healthcare provider or pharmacist.

But stronger painkillers would work better, wouldn’t they?

Not always. For many types of pain, paracetamol and ibuprofen work as well as weak opioids, with fewer side effects and no risk of dependence.

Related: Ibuprofen vs paracetamol · Codeine and tramadol

Sources: National Institute for Health and Care Excellence, British National Formulary (BNF), US Food and Drug Administration, World Health Organization, NHS.