Congratulations, you injured yourself doing something active. Such things are liable to happen when you leave the couch. But the choice between Advil, Panadol, aspirin and so many other pills can be daunting. Here's what you should reach for and when.
We asked our friend Dr Sameer Dixit, MD, primary care sports medicine physician at the Johns Hopkins University School of Medicine, to weigh in. Here's his simple guide.
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From Dr Dixit:
Every patient is an individual and any advice (on the internet or elsewhere) should be taken with a grain of salt as well as some knowledge of one's own body, health issues, personal habits, and exercise goals. Unfortunately, nothing we say is applicable to everyone, and as they say, "individual results may vary".
Furthermore, we cannot account for allergies or other conditions you may have that could cause complications. Most of these medications are generally well-tolerated (with some of the critical exceptions noted below), however Dr Dixit notes that just because these are available over the counter, that "doesn't mean that they cannot cause fairly significant issues in people. Therefore, they should be taken as any other medication is taken, with knowledge of the risks and benefits."
No internet advice can take the advice of a doctor's evaluation of you. Got that? No, really. Got that? OK then. Here we go.
Why Take Pain Relief Pills At All?
Health, fitness and sports communities are chock-full of beliefs about what medications are best for which circumstances. Some claim that high doses of ibuprofen for a solid month can cure just about anything though magical healing properties. Dr Dixit begs to differ.
"When using either NSAIDs (e.g. aspirin, ibuprofen, naproxen, diclofenac, celebrex, etc) or paracetamol (e.g. Panadol), the primary reason for use is to help with pain. That's it. None of them help cure or fix the issues involved and none have been shown to expedite the healing process. And, in fact, theoretically, NSAIDs could delay healing in both acute and chronic injuries." So don't expect anything beyond a little temporary relief.
At the same time, we shouldn't minimise the importance of pain relief. "Helping the patient become more comfortable may allow for the ability to play a sport, tolerate rehab, be able to go to work, or just get through the day," says Dixit. "Depending on the patient and what activity they are pursuing, some or all of these can be very important."
In other words, there are risks and there are potential rewards. Ultimately, it's up to you (and your doctor) to determine if the potential benefits outweigh the risks.
Again, taking a moment to remind you that these are not rules that you can just blindly follow.
"If pain is the issue, then I would generally start with acetaminophen (paracetamol)," says Dr Dixit. It typically does a great job with palliative relief for pain and is generally safer when consumed at the correct dosage; however, there are some extremely important exceptions. For paracetamol, the risks are primarily related to overdosing in general, and liver toxicity in particular. This is usually only an issue with higher doses and in people who have other reasons that their livers are susceptible to issues, most commonly heavy alcohol consumption. Got that, drinkers? Panadol is not a good hangover cure.
People also get in to trouble with paracetamol by taking too much of the over-the-counter stuff, and/or by mixing it with other medications that they may not know also contain paracetamol, such as Vicodin, Percocet, and even some over-the-counter cold and flu remedies. "Overdoses of acetaminophen (paracetamol) can lead to liver failure and death," notes Dixit. "Thus, when someone does inadvertently do this, it has grave consequences. In fact, the leading cause of liver failure in the US is acetaminophen (paracetamol) overdose. Hence, the US Federal Drug Administration black box warning."
But, again, the primary issue here is overdose, either taking too much or combining it with alcohol. At appropriate doses in healthy people, this should not be an issue.
If paracetamol isn't giving you the relief you require, then you may want to try an NSAID, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), etc. Again, we're primarily looking for pain relief here, however some NSAIDs may decrease swelling. That isn't necessarily a good thing though.
According to Dr Dixit, "With NSAIDS, the primary side effect profile includes gastrointestinal issues (nausea, vomiting, dyspepsia and most significantly GI bleeding), increased bleeding (by decreasing how effective your platelets are) and renal (kidney) side effects." So, that's fun. What's also significant is that — marketing hype aside — these medications are all very similar.
"To the best of our knowledge, aspirin, naproxen, ibuprofen and other NSAIDs have a similar mechanism of action in terms of how they help with pain," says Dixit. "I often choose naproxen over ibuprofen, primarily because it is twice a day and thus easier to take than ibuprofen, which can be three to four times a day, depending on the dose you're taking."
So, which should you go with? "All in all, if you are taking both types of medications at the appropriate dose, then acetaminophen (paracetamol) is likely the safer medication," says Dixit. Again, assuming you aren't an alcoholic or suffering from other liver problems.
We asked Dr Dixit to weigh in on some specific examples of when someone might be heading to the pain relief isle. Every individual and every injury is different, so don't take this as gospel.
Ankle sprain: Any "If swelling and stiffness are especially bothersome after the injury, then NSAIDs may help discomfort a little more."
Bruise from impact (arm or thigh): Any "I would start with Tylenol (paracetamol). When bleeding is the cause of discomfort (such as what occurs in a bruise) NSAIDs can theoretically increase bleeding."
Muscle soreness from overuse: Any "Acetaminophen (paracetamol) or NSAIDs are fine, but the true treatment is rest and allowing your body to heal from the activity. Additionally, rehab geared towards assisting with the issue can bring about a faster return to activity."
Concussion: Paracetamol "We generally recommend acetaminophen (paracetamol) early in the course of a concussion, in case it isn't only a concussion. With brain injury, there is a rare risk of intracranial bleed, and NSAIDS can increase bleeding risk."
Long-term rehab: (example: rehabbing a rotator cuff): Any NSAIDs may help if there's swelling or stiffness.
Sun burn: Any "Make sure to stay hydrated."
Broken arm: Paracetamol "There are good in-vitro studies that show delayed bone healing with NSAIDs. This has not been shown in human studies/trials, but because of the theoretical risk of delaying bone healing, I always start with Tylenol (paracetamol)."
Fever: Any "Tylenol (paracetamol) is generally what I ask patient's to start with."
Tendon or ligament pain: It's complicated
Ligaments and tendons are strange beasts, according to Dr Dixit. For example, the ACL doesn't have any pain fibres. It's the inflammation around it that causes the pain. So in that case an NSAID may be beneficial, but when you're dealing with tendons and ligaments, you should really be evaluated by a medical professional.
Huge thanks again to Dr Sameer Dixit for all his time and help.