Pain Management Over-The-Counter Welcome to Doctors Dialogue, featuring the doctors of This segment features Dr. Dennis Lee, Board certified in Internal Medicine and Gastroenterology, and Dr. William Shiel, Board certified in Internal Medicine and Rheumatology. Dr. Lee will be asking Dr. Shiel pertinent viewer submitted pain management-related questions.

Dr. Lee: Many pain medications are available over-the-counter (without a prescription, or OTC) in the U.S. for short-term relief of joint pain, muscle aches, headache, menstrual cramps, and fever. These OTC analgesics are generally well tolerated and safe when used properly. But side effects do occur and in some instances can be serious. Today, we will ask Dr. William Shiel how to use these analgesics properly in order to minimize risks and side effects. We will also ask him to compare traditional pain relievers with the newer pain relievers, the selective COX-2 inhibitors.

What pain medications are available in this country without a doctor's prescription?

Dr. Shiel: There are two major classes of pain relievers available in this country without prescription; they are acetaminophen (Tylenol) and Non-steroidal anti-inflammatory drugs (NSAIDs).

Dr. Lee: What are Non-steroidal anti-inflammatory drugs?

Dr. Shiel: Non-steroidal anti-inflammatory drugs are medications that impair the production of prostaglandins in the body. Prostaglandins are natural compounds that are responsible for producing fever, pain, and inflammation.

Dr. Lee: Why are they called non-steroidal anti-inflammatory drugs?

Dr. Shiel: They are called non-steroidal anti-inflammatory drugs because they reduce inflammation without the side effects of steroids. Steroids (Prednisone, Cortisone, Medrol, etc.) are potent medications that reduce inflammation, but steroids have predictable and potentially serious side effects, especially with long-term use. Non-steroidal anti-inflammatory drugs do not have these steroid side effects.

Dr. Lee: Can you give me some examples of non-steroidal anti-inflammatory drugs that are available OTC?

Dr. Shiel: Yes, examples of OTC NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve).

Dr. Lee: Are steroids such as Medrol, Prednisone, and Cortisone pain relievers?

Dr. Shiel: No, steroids are not pain relievers. But this is a common misconception Dr. Lee. Steroids, including Cortisone, are potent medications that reduce inflammation. And reducing inflammation can cause the pain to gradually subside. But steroids are not used specifically for quick pain relief.

Dr. Lee: How are over-the-counter NSAIDs different from NSAIDs that need prescriptions from the doctor?

Dr. Shiel: In fact, many over-the-counter NSAIDs have the same active ingredients as prescription NSAIDs. The difference is in the amount of active ingredient contained in each tablet or capsule, and in the dosing requirements (how often one has to take these per day).

For example, Aleve is available over-the-counter and contains 220mg of naprosen sodium per pill, while Naprosyn needs a doctor's prescription and may contain 375mg or 500 mg per pill.

Dr. Lee: Let me get back to the over-the-counter pain relievers. How is acetaminophen different from NSAIDs?

Dr. Shiel: Acetaminophen reduces pain and fever by acting on the brain. NSAIDs reduce pain and fever by reducing prostaglandin production and inflammation at the site of pain (ankle, knee, shoulder, etc.) Acetaminophen is generally considered easier on the stomach than NSAIDs.

Dr. Lee: How is aspirin different from the other NSAIDs like Aleve, Motrin or Advil?

Dr. Shiel: Aspirin, Aleve, Advil/Motrin are similar in reducing pain, fever and inflammation. But aspirin has more prolonged anti-platelet effect than the other NSAIDs.

Platelets are small particles in the blood that initiate blood clot formation. For example, a heart attack is usually caused by a blood clot blocking the flow of blood in an artery to the heart. Aspirin inhibits the platelets from forming blood clots, and therefore is being used in low dose to prevent heart attacks and strokes.

The other NSAIDs also have anti-platelet effects. But their anti-platelet action does not last nearly as long as aspirin