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.

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.”

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.

In 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.