pain relievers

Choosing the right  pain reliever

Choosing the right over-the-counter pain reliever

There are lots of oral over-the-counter products available to treat pain and fever, but which one is the right one for you? To help you choose the best product for your needs, there are two main things to consider:

  • How well they work. Both paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen and diclofenac, are effective in treating mild-to-moderate pain and reducing fevers.1
  • How suitable they are. All over-the-counter pain relievers are generally safe, but not every pain reliever is right for everyone. Some people need to take particular care when it comes to choosing the right analgesic for them.

This article takes a closer look at some of the suitability issues you should consider when selecting a pain and fever reliever.

A question of age

The age of the person needing pain relief is an important factor to consider when choosing a pain reliever. Care needs to be taken when giving any medication to children, as the way they respond to medication is different to the way that adults react.2 For example, while an adult can take aspirin, this should be avoided in children under the age of 16 years because of the potential risk of a serious condition called Reye’s Syndrome that can affect the brain and liver.3

The only pain relievers that can be used in children under the age of 12 are paracetamol and ibuprofen. Both products are equally effective in relieving pain and fever in children, including high fevers.4-6 Paracetamol can be given to children from the age of 3 months (on your doctor’s advice) and two months for post vaccination pain and fever.7 Ibuprofen can be given from the age of six months.7   

Older people also need to take care when choosing a pain reliever. As we age, our bodies don’t work as well as they used to. In addition to suffering from health problems, such as aching joints or heart disease, it also makes us more likely to experience side effects when taking another medication.8 For older people, it’s important to choose a pain reliever that is not likely to cause side effects and can be taken with a medication that they may need for other health problems. Experts recommend paracetamol as the pain reliever of choice for older people because of its efficacy and safety.8

Other health problems

If you have other health problems, you also need to take care when choosing an OTC pain reliever.

Stomach problems. If you have a stomach ulcer or have had a stomach ulcer in the past, you need to avoid NSAIDs. The reason for this is because NSAIDs have the potential to cause serious stomach problems, like ulcers.1 Instead, you can use paracetamol for pain relief.

Heart and high blood pressure problems. If you have severe heart failure you need to avoid NSAIDs,1 as using these can lead to other problems in the body.1 The exception is low-dose aspirin, which is used to help prevent a further heart attack in people who have had one before. If you have other types of high blood pressure, speak to your doctor or pharmacist, as NSAIDs can cause some side effects.1 If you have heart or high blood pressure problems, then paracetamol may be a suitable choice for you.

Inflammatory bowel disease. The medical conditions ulcerative colitis and Crohn’s disease can be made worse by taking NSAIDs,9 so speak to your doctor or pharmacist for advice. If you have inflammatory bowel disease, paracetamol may be suitable for you.

Asthma.  In around 1 in 5 asthmatics, taking NSAIDs can trigger an asthma attack.10 If you are concerned that you maybe one of these people, speak to your doctor or pharmacist for advice. Paracetamol may be a suitable option for you.

Bleeding problems. If you have a medical condition that means you are at increased risk of bleeding, you may need to take care before taking NSAIDs.1 That’s because they can affect the way your blood clots. Paracetamol may be suitable for you. However, if you have to take blood-thinning medication, it’s best to speak to your doctor or pharmacist as all pain relievers can affect the way some of these medicines work.

Kidney problems. If you suffer from severe kidney problems it’s best to speak to your doctor or pharmacist for advice, as both paracetamol and NSAIDs have the potential to affect the way your kidneys function.1

Liver problems. If you suffer from severe liver problems it’s best to speak to your doctor or pharmacist for advice, as both paracetamol and NSAIDs have the potential to affect the way your liver functions.1

Pregnant women. If you’re pregnant, it’s best not to take any medication as there is a risk that the medication may be passed on to the unborn baby and cause problems. Aspirin should be avoided in pregnancy and most other NSAIDs cannot be used in the last three months of pregnancy.10 Paracetamol can be used but, like all medication taken during pregnancy, you should speak to your doctor, pharmacist or midwife for advice first.

Taking other medication?

If you have other health problems you may also need to take other medication. These have the potential to interact with pain relievers, which can affect the way they work, or can lead to side effects.

Paracetamol interacts with:

  • some blood-thinning medications, if you take paracetamol every day. Taking the occasional paracetamol dose has no effect on blood-thinning medications.

NSAIDs interact with:10

  • other NSAIDs
  • steroid medication
  • drugs to reduce blood pressure and water retention
  • some antibiotics
  • blood-thinning medications
  • some anti-depressant medications
  • some heart drugs
  • some cancer-treating medications
  • some anti-HIV drugs.

It’s important for you to find a pain reliever that eases your pain and won’t cause you other problems. Always read the label of your medication to make sure your pain reliever is suitable for you. If you’re still not sure, ask your doctor or pharmacist for advice.


  1. Martindale: The Complete Drug Reference. 36th Edition, March 2009.
  2. Children’s British National Formulary 2010-2011.
  3. NHS Choices. Reye’s Syndrome.
  4. Walson PD, et al. Comparison of multidose ibuprofen and acetaminophen therapy in febrile children. AJDC 1992; 142:626-632.
  5. Autret-Leca E, Gibb IA, Goulder MA. Ibuprofen versus paracetamol in pediatric fever: objective and subjective findings from a randomized, blinded study. Curr Med Res Opin 2007; 23: 2205-2211.
  6. Schachtel BP, Thoden WR. A placebo-controlled model for assaying systemic analgesics in children. Clin Pharmacol Ther 1993; 53:593-601.
  7. Nurofen for Children UK Summary of Product Characteristics.
  8. American Geriatrics Society Panel on the pharmacological management of persistent pain in older persons. Pharmacological management of persistent pain in older persons. JAGS, 2009; 57:1331-1346.
  9. Nurofen Summary of Product Characteristics.
  10. Jenkins C, et al. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ, 2004; 328:434.