How to Choose the Best Over-the-Counter Pain Medicine

How to Choose the Best Over-the-Counter Pain Medicine

Pain is one of the most challenging symptoms to treat. It can be caused by many different things such as heat, cold, pressure, traction, inflammation, and nerve damage. Over-the-counter (OTC) pain medicines offer a wide variety of treatment options for the various types of pain. It’s important to understand the cause of your pain in order to choose the best medicine(s) to treat it. I’ll review some of the most common types of pain, and explain which active ingredients are best suited to provide relief.

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How to Choose the Best Over-the-Counter Pain Medicine

How to Choose the Best Over-the-Counter Pain Medicine

How to Choose the Best Over-the-Counter Pain Medicine

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Author & Expert Contributors
written by
Val Jones, M.D.
Author & Expert Contributors
written by
Val Jones, M.D.
Content medically reviewed by
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Pain is one of the most challenging symptoms to treat. It can be caused by many different things such as heat, cold, pressure, traction, inflammation, and nerve damage. Over-the-counter (OTC) pain medicines offer a wide variety of treatment options for the various types of pain. It’s important to understand the cause of your pain in order to choose the best medicine(s) to treat it. I’ll review some of the most common types of pain, and explain which active ingredients are best suited to provide relief.

Headaches & Migraines

Believe it or not, doctors are still not completely sure what causes headaches. The Mayo Clinic notes, “Chemical activity in your brain, the nerves or blood vessels of your head outside your skull, or muscles of your head and neck — or some combination of these factors — may play a role in primary headaches.”

The most common kind of headache is known as a “tension headache” and as the name suggests, it often feels like a tight band around your head. Aspirin, ibuprofen, naproxen, and acetaminophen all are effective to treat tension headaches, but it’s important not to overuse OTC headache medicines or else you may experience headaches from the medicines themselves. According to physician resource Up to Date, “over-use headaches” can occur if you use these medicines for more than nine days over the course of a month.

Migraine headaches are much more severe than tension headaches, and may cause a throbbing feeling in one specific part of the head, accompanied by nausea, vomiting, and light and sound sensitivity. These headaches are responsive to aspirin, acetaminophen, and caffeine in combination, and ibuprofen.

There are other less common types of headache, which are described here.

Red Flags

Most headaches are not dangerous and eventually resolve on their own. However, there are certain symptoms that may indicate that there is something else going on. Call your doctor if:

  • You experience the sudden onset of an extremely severe headache (unlike any other you’ve ever had)
  • You experience a chronic headache that is worse in the mornings
  • Your headache is accompanied by other unusual symptoms (such as weakness or slurred speech)

Arthritis Pain

Arthritis literally means “joint inflammation” and it is one of the most common causes of pain experienced by adults. Most arthritis is due to normal “wear-and-tear” on joints and is known as osteoarthritis. There are less common types of arthritis that are caused by an autoimmune reaction to joint tissues (such as rheumatoid and psoriatic arthritis).

Non-steroidal anti-inflammatory drugs (NSAIDs) work at the level of the joint to reduce enzyme production that leads to inflammation. Ibuprofen, naproxen, and aspirin are the most popular active ingredients in OTC NSAID treatments.

Acetaminophen works by reducing inflammatory chemicals (called prostaglandins) in the central nervous system (spinal cord and brain) and can block pain impulses from nerves in the joints.

Capsaicin (a derivative of chili peppers) cream works by depleting nerve endings of their primary pain transmission chemical (called “substance P”). Keep in mind that it takes between one and six weeks of regular application of the cream to experience the full pain-relief effects. Be sure to wash your hands carefully after each application as the hot pepper extract can be very painful if it gets into your eyes by accident.

As with headache treatment, it’s important not to overdose on NSAIDs and/or acetaminophen because high doses of NSAIDs can increase your risk for stomach irritation, bleeding, heart attacks, and ulcers while overdoses of acetaminophen can cause liver damage. Always adhere to the proper drug dosing instructions on the drug facts label.

Red Flags

Pain that is severe enough to keep you from being able to bear weight (especially if you’ve had a recent accident or injury) may be a sign of a fracture. Joint pain accompanied by fevers (and/or redness and swelling) could mean that you have an infection in your joint. Both of these require rapid assessment by a healthcare professional.

Important Update: Acetaminophen

There’s been a lot of talk recently about misleading claims that taking acetaminophen during pregnancy can cause autism. We’ve pulled together some FAQs and answers to help families.
Learn more and get the facts about acetaminophen

Muscle Pain

Muscle pain is usually caused by micro-tears in muscle fibers that stimulate nerve endings in the surrounding tissues. Nerve endings that sense inflammation, stretch and pressure exist near muscle tissue and their messages are usually perceived by the brain as dull, aching pain sensations. People experience muscle pain most commonly after exertion or exercise. In addition to oral anti-inflammatory medicines, acetaminophen, and NSAIDs, many OTC muscle pain treatments involve the application of heat, or superficial cooling and anti-inflammatory creams. The active ingredients in topical consumer products that have been found to be helpful in easing muscle pain and soreness are: menthol, camphor, methyl salicylate, capsaicin, heat wraps, and cold packs.

Red Flags

If your muscle is sore and you are unable to move a joint through its full range of motion, it’s possible that there is a ligament or tendon tear present. Muscle soreness that doesn’t begin to resolve after several days, or if there is any new weakness present, could be an indication of something more serious, such as a nerve injury or autoimmune condition. Contact your doctor if you experience any of these “red flags.”

A NOTE ABOUT DYE-FREE PRODUCTS: Dye-free medications and supplements are a great option for individuals who prefer or require products without dyes, such as those with allergies, sensitivities, or personal preferences. Importantly, both dye-containing and dye-free options are held to the same rigorous safety and quality standards. If you’re unsure which is right for you or your family, talk to your pharmacist or healthcare provider. They can help you choose the option that best suits your needs.

Nerve Pain

Sometimes, the pain messaging system itself becomes damaged. Pinched nerves, herniated disks, and various peripheral neuropathies (such as carpal tunnel syndrome) are quite common. Nerve pain usually causes a tingling or burning sensation, with possible “electric shock” feelings, numbness, and when severe, weakness. Unfortunately nerve pain can be hard to treat. Please note that NSAIDs and acetaminophen are rarely helpful in treating nerve pain, so they should be reserved for other kinds of pain.

Wrist splints can be helpful in the treatment of carpal tunnel syndrome. They work by preventing excessive wrist bending that can occur when you’re typing, working, or sleeping. This can reduce pressure on the nerve that is being compressed at the level of the wrist.

If you need treatment for nerve pain, you should talk with your healthcare provider.

Red Flags

New onset of muscle weakness (in addition to pain and tingling) is a medical emergency. Pinched nerves that result in muscle weakness may require surgical relief. If weakness is ignored, it may become permanent. New onset nerve pain symptoms should be evaluated by a healthcare provider since underlying conditions such as diabetes, infections, toxin exposure, and genetic conditions should be ruled out.

Conclusion

Pain treatment can be quite complicated. When you consider all the brands, possible combinations, and different formulas and ingredients, there are hundreds of safe and effective OTC pain management options available. Understanding which treatments are appropriate for you is important. While mild to moderate pain can frequently be treated effectively with OTC medicines, pain can be a symptom of serious conditions and medical emergencies, so it’s crucial to contact your doctor right away if you experience any of the red flags above (or other concerning symptoms). Emotional factors can also play a significant role in how pain is perceived by the brain, and regular exercise, stress management, good sleep hygiene, and healthy lifestyle choices are an important part of managing pain.

Safe Use Tips & Takeaways

Heart Health Takeaways

Frequently Asked Questions (FAQ)

What is fluoride?
Fluoride is a natural mineral found in water, soil, and some foods. It strengthens your enamel, repairs early signs of damage, and makes teeth more resistant to acids from bacteria and sugar.
Is fluoride toothpaste still the most effective option, or are fluoride-free formulas just as good?
Fluoride is still the gold standard for cavity protection. Fluoride-free options can clean your teeth, but they don’t offer the same enamel-strengthening power.
Is fluoride safe for daily use?
Yes. When used as directed, fluoride is safe and effective. It’s been trusted and recommended by major health organizations for over 70 years.
How does fluoride actually protect teeth?
It strengthens enamel, repairs early signs of decay, and makes teeth more resistant to acids from bacteria and sugary foods.
Are there any risks to using fluoride long-term?
The main risk—especially for young kids—is swallowing too much, which can lead to mild fluorosis. Using the right amount prevents this. For parents, supervise brushing to ensure kids spit out the toothpaste and don't swallow it. 
At what age should kids start using fluoride toothpaste?
As soon as the first tooth appears!

* Under 3 years: a tiny rice-sized smear
* Ages 3–6: a pea-size amount  

Supervise brushing so they don’t swallow it.
Is fluoride still safe and recommended for kids with all the claims online?
Yes. A lot of online claims can be confusing, but decades of research show fluoride is safe and strongly recommended for cavity prevention when used properly.
How much fluoride should my child get from toothpaste?
Use age-appropriate amounts and brush twice a day. If your water isn’t fluoridated, ask your dentist about additional options.
How do I know which kids’ toothpaste claims are real and not just marketing?
Check for the ADA Seal of Acceptance and choose brands your dentist recommends.
Do fluoride-free or “natural” toothpastes protect kids from cavities?
They can help clean teeth, but they don’t provide the same cavity protection as fluoride toothpastes.
Are fluoride-free toothpastes just as effective for adults?
Not for cavity prevention. Fluoride-free toothpastes can help with cleaning and freshening breath, but they do not protect against cavities the way fluoride does. For adults, or anyone who is prone to cavities, fluoride toothpaste remains the most effective option for preventing tooth decay.
Do fluoride alternatives like nano-hydroxyapatite (nHAp) make a difference?
Yes—nHAp can help with sensitivity and early enamel repair. But it hasn’t matched fluoride’s cavity-prevention strength in studies.
How do I compare fluoride vs. fluoride-free options if I have sensitivity or enamel wear?
Fluoride is best for strengthening enamel. nHAp may help with sensitivity. Some people benefit from using both in a balanced routine.
Are whitening toothpastes safe to use with fluoride or fluoride-free products?
Most are safe but can be abrasive. Choose gentle formulas and avoid using them every single day—especially for kids.
What should I look for when choosing an OTC toothpaste?
Pick products with proven active ingredients (like fluoride), check for the ADA Seal, and avoid unnecessary additives or sweeteners.
Does fluoride affect hormones or the brain?
No credible scientific evidence shows fluoride at levels used in toothpaste or fluoridated water disrupts hormones or causes neurodevelopmental harm.
What should I do if my community stops adding fluoride to the water?
Use fluoridated toothpaste, consider fluoride rinses, and talk to a dentist about fluoride supplements for kids.
Do fluoride supplements have side effects?
They’re safe when used under dental guidance and typically recommended for children in areas without fluoridated water.
What’s the best way to make sure I’m getting enough fluoride?
Brush twice daily with fluoride toothpaste, drink fluoridated tap water if available, and ask your dentist for personalized advice if you’re cavity-prone.

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