Over-the-counter pain medications

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woman buying medication

The main over-the-counter pain medications include:

Tip: The tables below are best viewed in landscape mode if you are accessing this page on a smartphone, tablet or other mobile device.​

Acetaminophen

General points to note

  • When used in prescribed doses, and for the short term, acetaminophen is a safe and effective pain reliever.
  • It is recommended to limit the dose to 3 g a day, as there have been reports of liver injury at doses of less than 4g per day.
  • Generic acetaminophen works just as well as a brand name version and usually costs less.
  • Many medications include acetaminophen with other medicines. For example oxycodone or tramadol may include acetaminophen. Even your cold medication or sleep aids might include acetaminophen. Always tell your doctor or nurse about all drugs that you are taking to make sure that you are not exceeding the recommended dose.
  • If you have migraine pain, do not take acetaminophen on more than 10 days per month, as it can make your headaches worse.
Generic name Brand name How you take itHow it works Side effects
AcetaminophenTylenolOral pillThought to reduce pain by affecting parts of the brain that receive pain messages
Common
  • None, if used as prescribed
Rare
  • Diarrhea
  • Loss of appetite
  • Stomach pain or cramps
  • Skin rash, hives or itching
  • Swelling of face, lips, tongue and throat 
  • Increased sweating
  • Yellow eyes or skin

Non-steroidal anti-inflammatory drugs (NSAIDs)

General points to note

  • NSAIDs are commonly used to treat headaches, toothaches, muscle aches and menstrual cramps.
  • One of the most commonly used NSAIDs is called ibuprofen. Some brand names for ibuprofen are Advil® and Motrin®.
  • They work best in short courses to manage flare-ups of pain related to inflammation – usually shown by redness, swelling or heat.
  • NSAIDs work by interfering with particular enzymes in your body, which results in reduced inflammation and pain.
  • NSAIDs may be used with acetaminophen and opioids to more effectively manage some chronic pain conditions such as musculoskeletal pain.
  • There are many types of NSAIDs, but you can only take one type at a time.
  • Some NSAIDs, such as ibuprofen and naproxen, are available over the counter, but others, such as diclofenac, meloxicam and celecoxib, are only available by prescription. The prescription medications section describes prescription NSAIDs.
  • Before using NSAIDs, tell your doctor if you have a bleeding disorder, asthma or kidney problems or if are undergoing chemotherapy or have ever had a stomach ulcer.

Side effects

  • One of the most common side effects of NSAIDs is stomach upset. Usually, you can avoid this by taking the correct dose and taking the medication with food, even just a glass of milk or some crackers.
  • When used regularly for a long time, or in high doses, NSAIDs can cause kidney problems and stomach ulcers. This can lead to dangerous bleeding and perforations. If you experience blood in bowel movements or severe stomach pain while taking NSAIDs, see your doctor or nurse practitioner right away and stop taking the medication.
  • In very rare cases, NSAIDs can cause bleeding problems. If you are taking NSAIDs, you may need to stop them for a period if you need to have surgery.
  • If you have migraines, don’t take NSAIDs on more than 15 days of the month, as they can make your headaches worse.
Generic name Brand name How you take itHow it works Side effects
IbuprofenAdvil
Motrin
Oral pill
  • Reduces hormones that cause inflammation and pain
  • Effects usually last 4 to 6 hours
Common
  • Stomach upset

Rare
  • Bleeding problems
NaproxenAleveOral pill
  • Blocks a certain natural substance in your body to reduce pain and swelling
  • Effects last up to 12 hours
Common
  • Stomach upset

For more information about how ibuprofen works, watch the video below. Note that Aspirin is typically not recommended for young people with chronic pain because of the risk of some rare but severe side effects.

Topical analgesics

General points to note

  • Topical analgesics (pain relievers) are creams and ointments that you apply to the skin to numb the nerves just under the skin’s surface and treat pain in the immediate area.
  • Topical creams and ointments can sometimes be applied for longer periods to relieve chronic pain, usually when used with other medications such as opioids, NSAIDs, anticonvulsants or capsaicin (a substance derived from hot peppers).
Active ingredient Brand nameHow it worksSide effects
LidocaineMaxilene
Ela-Max
EMLA
  • Temporarily blocks the pain signals from the skin
Rare
  • Skin rash
CapsaicinCapzasin-P
Zostrix
  • Inhibits parts of the pathway responsible for pain reception, which is needed to feel pain
Common
  • Burning feeling, which can be painful before the relief starts
SalicylatesTiger Balm
RubA535
  • Chemically similar to aspirin, but the way they work is not well understood
  • Many creams are mixed with menthol, which gives a heat and cooling effect on the skin that may help soothe pain
May cause serious side effects where the cream was applied, such as severe burning, pain, swelling or blistering. Seek medical attention right away if you experience any of these serious side effects.
Diclofenac sodiumVoltaren emulgelA type of NSAID that blocks a certain natural substance in your body to reduce joint pain and swellingMay cause skin rash, pain, tingling or burning sensation at the application site. May also cause body ache/headache, fever or itchy skin.

Sources

American College of Rheumatology (2015) NSAIDs (Nonsteroidal anti-inflammatory drugs)​. Rheumatology.org [Accessed April 22, 2016]​

Hospital for Sick Children Chronic Pain Clinic. What we do. SickKids.ca [Accessed April 22, 2016]​​​

Taddio, A. (2009) Acetaminophen, Aspirin and NSAIDs. AboutKidsHealth.ca [Accessed August 27, 2018]

Last updated: May 2nd 2016