Are you or a loved one dealing with persistent pain but confused about what medications are safe? Understandably so! Treating persistent pain can be challenging and now warnings about the risks of leading pain relievers have left many of us wondering what we can do to safely treat our pain.

News in recent years warned about the risks of two well-known pain relievers—acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs). Despite risks including liver damage, and gastrointestinal and cardiovascular conditions, these medications can be taken safely to treat pain. The key to lowering risk is following treatment directions and never taking more than instructed.

Acetaminophen and Potential Liver Damage

Acetaminophen is the generic name of a drug that’s an active ingredient (an ingredient that causes a drug to have its effect) in more than 600 over-the-counter (OTC) and prescription medications. While it is probably most well known as the active ingredient in Tylenol®, it is also found in medications such as Excedrin®, Dayquil®, Nyquil®, Vicodin®, and Percocet®. Acetaminophen is a widely-used drug for both relieving pain and reducing fever; unfortunately, it has also been found to cause liver damage in people taking too much.

The recommended daily allowance (RDA) for acetaminophen is 4,000 mg—a very important number to remember because taking more can lead to overdoses and liver failure. Acetaminophen overdoses land an estimated 110,000 people in the ER each year, and the drug is the leading cause of liver transplants in the U.S.

As scary as this all sounds, acetaminophen is safe and effective if taken correctly. Be sure to carefully read all labels and keep close track of the amount you take each day. Keep in mind that acetaminophen is also found in a number of combination drugs—drugs with more than one active ingredient to combat more than one condition at a time—like cold medicines that treat congestion and pain in one pill. If you are taking any combo drugs, make sure you count any acetaminophen towards your daily total.

You should also always talk to your doctor before taking any new medications. Discuss all current medications, including OTCs and supplements. Be sure to tell your doctor if you drink three or more alcoholic drinks a day or have liver disease, since both can put you at increased risk of liver damage.

The Controversy Behind NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used pain relief medications for many types of pain. They are available as both prescription and OTC medications, and work by blocking the COX enzymes (COX-1 & COX-2) which promote inflammation, pain, and fever.

Traditional NSAIDs, such as Aspirin and Ibuprofen, block both COX 1 and COX 2. These NSAIDs can cause stomach upset, ulcers, and bleeding but also offer some protection against heart disease. Many people, in consultation with their health care professional, take Aspirin daily to protect their hearts.

COX-2 inhibitors, which block only COX-2 and include the drug Celebrex®, do not have as high a risk of stomach and gastrointestinal problems. However, they can increase the risk of heart attack, stroke, and other cardiovascular conditions. Both Vioxx® and Bextra® were withdrawn from the market because they excessively increased the risk of heart attack and stroke.

The withdrawal of these drugs led to much confusion and controversy regarding the safety of NSAIDs. However, available NSAIDs are considered generally safe and may even offer some protective benefits. Be sure to talk to your doctor before taking any NSAID to find out what’s right for you and how to take it safely.

Safe Medication Use

As with all medications, it’s important to be informed and to tell your doctor, pharmacist, and all of your health care professionals what medications and supplements you are taking.

You should also follow these steps for safer medication use:


• Keep a list of all medication and supplements you are taking—this will help both you and your doctor keep track of dosages and potential interactions.
• Carefully read all labels, paying special attention to active ingredients. Remember that although OTCs are sold without a prescription, that doesn’t mean they’re always safe and they should still be taken with caution.
• Before starting a new medication, talk to your doctor or pharmacist about potential interactions with medications you’re already taking.
• Be alert to signs of side effects or reactions. Contact a health professional immediately if you notice anything out of the ordinary.
• Take all medications exactly as the label and package inserts instruct (unless specifically directed by a health care professional).
• Keep track of total dosage amounts for all medications—remember to count combination drugs.
• Familiarize yourself with generic names of medications and ask if you’re unsure about any ingredients.

To learn more about safely treating pain, read the Alliance’s brochure Aging with Ease: A Positive Approach to Pain Management, which provides the latest information as well as advice from the American Geriatric Society’s 2009 Guidelines on controlling persistent pain in older adults.

Taking Control of Your Pain without Medication

In a recent Alliance for Aging Research survey that explored the attitudes, perceptions, and concerns of adults age 65 and older regarding pain management, 46% reported that they suffer from pain at least several times a week. While they may turn to pain relievers like acetaminophen and NSAIDs, there are also many safe and effective ways to relieve pain without medication. These techniques may be used in combination with drug treatments, or could be all that’s needed to take control of pain. Remember to talk with your health care professional about any pain relief techniques you use or are planning to use.

Some pain relief methods that you can use include cold packs, heat, massage, liniments, chiropractics, acupuncture, psychological counseling, talk or prayer, and physical or occupational therapy. (Read Aging with Ease to learn more). Talk to your health care professional about which methods are best for you and your type of pain.