Pain Medications: Choosing the Right One for You

By Phoebe Chi, MD

Advil. Aleve. Tylenol. Aspirin. Four widely used over-the-counter medications. How do you know if you are taking the right one?

The purpose of this post is to familiarize you with the major pros and cons of these medications as well as to help you differentiate who should and should not take them. Even if you already have a “go-to” medication, make sure you know these essential facts, which is summarized in the table below.

Be aware that many medications are simply combinations of these (Excedrin = Tylenol + Aspirin + Caffeine), so always look at your medication label to see what you are getting.

Tip: Taking any pain medication with a caffeinated beverage will often increase its effectiveness, as caffeine helps speed up absorption as well as potentiate its analgesic effects. This is why some medications, like Excedrin and Midol, already contain caffeine (60mg…about the same as a small cup of coffee).

Therefore, without further ado…

• Naproxen (Aleve) •

In a Nutshell:
Naproxen is the most effective one on this list for pain control and menstrual cramps and is also great for fever, joint inflammation, and migraines. It is the longest-lasting, so you usually only have to take it every 12 hours. However, it is the most irritating on the stomach (nausea, general upset), so always take with food and avoid if you have ulcers. Also, those with poorly controlled high blood pressure should use caution when taking naproxen, as it can further increase your blood pressure (effect varies depending on individual).

Best for:
Those needing longer-lasting moderate pain control and have no GI issues.

How to take:
Always with food

Avoid if:
You have stomach ulcers or frequent upset stomach, and use caution if you have issues controlling your blood pressure.

• Ibuprofen (Advil, Motrin) •

In a Nutshell:
Ibuprofen is effective for mild to moderate pain, fever, and joint inflammation. Can also be irritating to the gastric lining and cause nausea if taken on an empty stomach (but not as harsh as naproxen), so try to take with food. Effects usually only last 4-6 hours. Like naproxen, it also carries a slight risk of increasing your blood pressure. Think of this as a slightly less potent version of naproxen.

Best for:
Those needing general mild to moderate pain control.

How to take:
With food to avoid nausea and GI upset

Avoid if:
You have congestive heart failure (CHF), or have issues with high blood pressure.

• Acetaminophen/Paracetamol (Tylenol) •

In a Nutshell:
Tylenol, by itself, is adequate for mild pain and fever, but is not effective for more severe pain or inflammation. It is safe to take on an empty stomach or if you have stomach issues. However, overdose and liver damage is possible so be careful how much you take in a day. It can safely be combined with any of the other medications on this list and is also the only one that is considered safe for pregnancy.

Best for:
Pain control during pregnancy, people with sensitive stomachs

How to take:
Can take on empty stomach

Avoid if:
You have liver problems, or if you are taking another medication with acetaminophen in it (eg. cold/flu/sinus medications, many prescription pain medications).

• Aspirin •

In A Nutshell:
Helpful for mild pain or headaches, but its benefits lie in its ability to prevent and improve heart disease. However, because it lowers your body’s ability to coagulate blood (‘thins the blood’), it is better to avoid aspirin if you are at risk for bleeding (eg. ulcers) or have frequent falls. Also, never give to children (can cause Reye’s syndrome).

Best for:
People with heart disease or have history of heart attacks

How to take:
With food if stomach upset occurs

Avoid if:
Children, or someone with high bleeding or fall risk (eg. the elderly)


* The information here is for education purposes only and is not to be used in place of medical advice. Please consult your trusted health care provider before taking any medications. 

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