ANALGESICS AS PAIN RELIEVERS

We spend more than 2 billion dollars annually on internal (taken by mouth) analgesics, the largest sales category of OTC drugs in the United States. Although these pain relievers come in several forms, aspirin, acetaminophen (Tylenol, Pamprin, Panadol), and ibuprofen-like drugs such as naproxen (Aleve) and ketoprofen (Orudis) are the most common.

Aspirin relieves pain by inhibiting the body's production of prostaglandins. It brings down fever by increasing the flow of blood to the skin surface, which causes sweating, thereby cooling the body. Aspirin has also long been used to reduce the inflammation and swelling associated with arthritis. Recently it has been discovered that aspirin's anticoagulant (interference with blood clotting) effects make it a useful medication for reducing the chances of repeat heart attacks for people who have already had one heart attack.

Despite the fact that aspirin has been commonly used as a medication for nearly a century, it is not as harmless as many people think. Possible side effects include allergic reactions, ringing in the ears, stomach bleeding, and ulcers. Combining aspirin with alcohol can compound aspirin's gastric irritant properties.

In addition, research has linked aspirin to a potentially fatal condition called Reye's syndrome. Children, teenagers, and young adults (up to age 25) who are treated with aspirin while recovering from the flu or chicken pox are at risk for developing the syndrome. Aspirin substitutes are recommended for people in these age groups.

Acetaminophen is an aspirin substitute found in Tylenol and related medications. Like aspirin, acetaminophen is an effective analgesic and antipyretic (fever-reducing drug). It does not, however, provide relief from inflamed or swollen joints. The side effects associated with acetaminophen are generally minimal, though overdose can cause liver damage.

In 1985, certain drugs containing ibuprofen (prostaglandin inhibitors) were switched from prescription to OTC status. Generally marketed as arthritis or menstrual cramp relievers, these drugs are milder versions of the prescription varieties. Examples are Nuprin and Advil.

In 1994, Aleve, the first new type of nonprescription analgesic to become available in a decade, was introduced onto the market. Aleve is a version of the prescription drug Anaprox, a fast-acting, slightly less strong form of the analgesic naproxen. Compared with the other OTC analgesics, Aleve's main distinction is its lasting effect: while the others need to be taken every 4 to 6 hours, once every 8 to 12 hours is sufficient for Aleve.