Health & beauty
Pain relievers
Introduction
Just choosing a painkiller can give you a headache!
For serious or long-lasting pain you should talk to your pharmacist or doctor. But to fix a twinge - or a one-off headache - you can pick up a painkiller from the supermarket ... but which one?
We compare types and common brands of over-the-counter pain relievers, and look at the kind of pain each one is best for.
What's the difference?
We found 22 painkillers on the shelves of one Wellington supermarket (and that doesn't include the various pack sizes).
You could choose which pain you wanted to treat (back, neck, migraine, tension headache, period pain) and how you wanted to treat it - with a tablet, caplet, capsule or gel cap. But just how different are they?
Active ingredients
Most pain relievers sold in supermarkets are based on one of three active ingredients - aspirin, ibuprofen or paracetamol. While the levels of aspirin varied (usually between 300 and 500 milligrams per tablet), the other products we found contained either 500 milligrams of paracetamol or 200 milligrams of ibuprofen per tablet.
Tablets and caplets
Basic painkillers came as tablets or caplets (capsule-shaped tablets that may be easier to swallow). Nurofen usually cost the same but several stores charged more for Panadol caplets than for the tablets. You would often pay extra for capsules that contain a powder and for gel caps or tabs with a gelatine coating.
Marketing mania
It's all about creating a bigger shelf presence. By presenting different packs, types and claims, a brand stands out from its competitors - unless they're playing the same game too.
Fifteen of the 22 painkillers we found were either Nurofen (which contains ibuprofen) or Panadol (containing paracetamol). If you have a packet of Nurofen Tension Headache in the medicine cabinet, do you need to buy Nurofen Back Pain when your back starts playing up? Will Panadol Rapid bring faster relief than Panadol Back + Neck?
Formulation
There's no difference in formulation or, usually, price, between Nurofen Tension Headache, Period Pain and Migraine Pain. They're sold as 12-pack caplets and cost $6.99 in a supermarket.
Nurofen Back Pain has the same formulation as the other three. But it's sold in packs of 24 caplets and we paid $12.99 for our pack. So are these products any different from regular Nurofen caplets, which cost $7.24 for a 24-pack in the same store?
The manufacturer, Reckitt Benckiser, says its research has shown that consumers look for products that are suitable for their particular pain. The targeted products help customers quickly identify the best product for their pain. They cost more than regular Nurofen because they contain a different form of ibuprofen that's faster-acting but more expensive to produce.
Panadol Back + Neck caplets are the same as Panadol Rapid and cost the same - around $1.30 more than the same-sized (20) pack of regular Panadol caplets.
GlaxoSmithKline says Panadol Rapid is for a younger market that wants a fast reaction, while Panadol Back + Neck targets older shoppers. Both these products contain sodium bicarbonate so they're absorbed faster than regular Panadol.
- Tip: The house-brand painkillers (Pams is sold in New World and Pak'n Save; Signature Range in Woolworths and Countdown) have the same level of active ingredients as their regular leading-brand counterparts. But they cost $2 to $3 less for a similar-size packet.
Which painkiller?
Over-the-counter painkillers are safe for most people to use but it's important to read the label to check the product is suitable for you. You should talk to a doctor or pharmacist first if you have liver or kidney problems, are pregnant or taking other medicines, herbal remedies or dietary supplements.
Paracetamol
No one is sure how paracetamol works - probably by blocking pain messages to the brain.
- Common brands: Ethics, Pams, Panadol, Paracare, Signature Range.
- Good for: Relieving pain and reducing fever. Kinder on the stomach than aspirin and ibuprofen.
- Risks: Side effects are rare at the recommended doses, but if taken in larger doses or too often paracetamol can cause liver damage. Don't take it with other paracetamol treatments (such as cold or flu remedies).
- Maximum daily dose: Eight 500mg tablets for people aged 12 years and over (but a lower dosage for younger children). Paracetamol can be used for babies and small children as a liquid, bought from a pharmacy.
Aspirin
This is one of a group of drugs called NSAIDs (non-steroidal anti-inflammatory drugs) that work by slowing the body's production of prostaglandins, which cause pain and inflammation. Aspirin was the original NSAID.
- Common brands: Alka-Seltzer, Aspro, Disprin, Signature Range.
- Good for: Relieving pain and inflammation, and reducing fever.
- Risks: Aspirin may interact with other medicines, herbal remedies or dietary supplements. It can cause stomach irritation and bleeding if taken in high doses. Some people who have asthma may find aspirin makes their condition worse.
- Maximum daily dose: Depends on the level of aspirin in each tablet (maximum = 4000mg per day). Aspirin's not suitable for children under 12 because of the risk of Reye's syndrome - a rare and potentially fatal disease that attacks the brain and liver.
Ibuprofen
A newer NSAID than aspirin, ibuprofen has fewer and less severe side effects.
- Common brands: Nurofen, Pams, Signature Range.
- Good for: Relieving pain and inflammation, and reducing fever.
- Risks: Can cause stomach irritation and bleeding if taken in high doses. Some people who have asthma may find ibuprofen makes their condition worse.
- Maximum daily dose: Six 200mg tablets for people aged 12 years and over (but a lower dosage for younger children). Ibuprofen can be used for children over the age of three months, as a liquid bought from a pharmacy.
Our advice
- Supermarket house brands are much cheaper than leading-brand painkillers. And they give you the same level of active ingredients. Why pay more than you need to?
- Always read the instructions on the packet and follow the recommended daily doses for adults and children.
Medication-overuse headache
Sometimes using painkillers to treat a headache will simply make it worse. If you take a painkiller to treat a migraine or a tension headache for a long period (more than 15 days in a month or for longer than 3 months) your body may become used to the drug.
When you stop taking it, a "withdrawal" or "rebound" headache develops (the medical term is "medication-overuse headache"). So you start back on the painkiller and the vicious circle begins. In time you may end up taking painkillers almost every day.
If you take painkillers regularly for headaches, talk to your doctor about what alternatives are suitable for you.
More information
- Free online health information: www.moh.govt.nz/besttreatments
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Report by Bev Frederikson