QUESTION: I wake up in the morning and can’t help but notice aches and pains. I feel like I don’t need to make a doctor appointment just yet, but the pain distracts me from enjoying my day. Then when I arrive at the pharmacy to purchase an over-the counter pain reliever I am unsure of which medication is best. What pain reliever is recommended for older adults?
ANSWER: It may be tempting to assume that over-the-counter products are safe for anyone to take, but unfortunately there is no one-size-fits all approach when it comes to over-the-counter pain relief. For older adults, the choice of which pain reliever to use becomes even less clear-cut. The packaging contains a lot of warnings and it is often not made plain which product is safer to take. Below, I break down the most common pain relief options along with the risks and benefits that healthcare professionals associate with them.
Acetaminophen can be taken without too much worry when following the directions on the package. One important thing to always keep in mind before taking your next dose is that the recommended limit is 3 grams (3,000 mg) of acetaminophen per day. That would mean a maximum of 9-10 regular strength (325 mg) tablets per day or 6 extra strength (500 mg) tablets per day. Acetaminophen is broken down in the body by the liver, which makes it a great choice when you have a history of kidney problems. However it also means that taking too much acetaminophen can damage to the liver. The risk of damage is also much higher when taken with alcohol so be sure to avoid this combination. As long as you stay within the recommended limits, acetaminophen is typically a smart starting point for minor pain relief.
NSAIDS – Non-Steroidal Anti-Inflammatory Drugs (Motrin®, Aleve®)
As the name suggests, non-steroidal anti-inflammatory drugs, commonly referred to as NSAIDS, have anti-inflammatory properties that acetaminophen does not. This makes NSAIDs a more effective choice for pain involving muscle aches or painful joints. Unfortunately, NSAID use is often limited to short-term use because the anti-inflammatory benefits of NSAIDs can come with significant disadvantages. Even if you may have used ibuprofen safely for years, research in recent years have shown that NSAIDs are associated with an increased risk of events such as heart attacks and strokes. Regular NSAID use also carries the risk of the development of sores in the stomach lining and the possibility of bleeding.2 In fact, the continued use of NSAIDs is not recommended in older adults.
Keep in mind that not all NSAIDs are created equal. Each NSAID (some of which are available only by prescription) varies in risks for heart attacks and strokes as well as stomach bleeding. To determine which NSAID would be safer for you, talk to your doctor or pharmacist. They will also be able to ensure that NSAIDs will not interact with other medications that you take.
For more information on NSAIDs in particular see our other Ask the Pharmacist post: https://www.kelley-ross.com/nsaid-use-safe-appropriate/
But what about aspirin you may ask? Aspirin is still widely prescribed by doctors, but not typically for pain relief. While aspirin does have many of the same benefits that an NSAID might have for pain and inflammation, it is the ability of aspirin to prevent blood clots that sets it apart. Aspirin’s anti-clotting property makes it an effective choice in the prevention of strokes and heart attacks. So pain relief AND prevention of heart attacks? Sounds like an ideal choice, but the prevention of clots means that it also increases the risk of bleeding. When pain relief is the primary goal, aspirin is not the safest option.4
What if you already take aspirin for the prevention I mentioned above? What product can you take when you need pain relief? It is important to keep the risks of each medication in mind because they can add up. NSAIDs with daily aspirin use can increase the risk of stomach bleeding even further. If you use both an NSAID and aspirin, it is important to take aspirin at least 2 hours before ibuprofen. If taken at the same time your aspirin will not be as effective in preventing heart attacks and strokes.
Final Take-away Points
- Beware of combination products: Many combination products may contain NSAIDS, acetaminophen, or aspirin, so extra care should be taken when taking combination products with other OTC pain relievers. In many cases, the packaging may not make it clear that the ingredients are similar because of packaging that is focused for a specific purpose, such as Excedrin® Migraine which contains acetaminophen, aspirin, and caffeine.
- Let your healthcare providers know about your pain. While an over-the-counter product can be a great way to quickly address your pain, your doctor or pharmacist may be able to help you better understand your pain and can recommend a product that is safer and/or more effective.
- Remember to stay within safe daily limits!
Questions about the use of pain relievers and warfarin? See our video blog: https://www.youtube.com/watch?v=BvLY7oXmuIk
- Altyar A, Kordi L, Skrepnek G. Clinical and economic characteristics of emergency department visits due to acetaminophen toxicity in the USA. BMJ Open. 2015;5(9):e007368.
- Moore N, Scheiman JM. Gastrointestinal safety and tolerability of oral non-aspirin over-the-counter analgesics. Postgrad Med. 2018;130(2):188-199.
- American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227-46.
- Hennekens CH, Sechenova O, Hollar D, Serebruany VL. Dose of aspirin in the treatment and prevention of cardiovascular disease: current and future directions. J Cardiovasc Pharmacol Ther 2006; 11:170.