Which is the best over the counter OTC) pain Medication?
       by Larry Wirth, Pharmacist, JCHC
Compare this to which is the best automobile....what are you interested in, hauling, economy, speed, appearance etc?  The best pain medication for you is the one which will relieve your pain without causing any harmful affects while minimizing any annoying side effects.  This requires you to take into consideration your medical history, other medications you are taking, current medical conditions, any allergies, your age, and your family medical  history?
Actually it is less arduous a task to select a pain reliever as there are only a few ingredients on the over the counter (OTC) market.   
Currently available OTC pain relievers (analgesics) include:

• Acetominophen/Tylenol
• Ibuprofen/Advil
• naproxen/Aleve
• Acetylsalicylic acid/Aspirin. 

Even though there are relatively few individual pain or analgesic ingredients for OTC pain medication, there are a tremendous assortment of OTC pain medication products on the market adding to the confusion as to which medication one should use.  There are multiple brands of the ingredient ibuprofen for example, such as Motrin IB, Advil, etc as well as generic products.  In addition there may be multiple strengths, or dose forms such as gel caps, extended release caps, etc and to further confuse the patient there are numerous combinations of pain medications with cough and cold ,sinus, allergy, migraine, menstrual, and insomnia medications.
It is important to understand acetaminophen does not possess any anti-inflammatory activity. It will reduce a fever and relieve pain but will not reduce the swelling and inflammation due to a sprained ankle. 
While acetaminophen is currently available in 325mg, 500mg, and 650mg strengths regulator's are currently considering whether the this product should be limited to the 325mg strength as there have been numerous concerns with over dosage and liver toxicity.  Acetaminophen is in so many products, both prescription and OTC, it is very easy to exceed the 4000 mg/24 hr limit and if a person consumes alcohol, takes other medications which affect the liver (such as those for reducing cholesterol) or has compromised liver function the maximum daily dose is even less. (3250 mg/24hr or less).
Ibuprofen, naproxen, and aspirin are commonly known as NSAID's or non steroidal anti-inflammatory drugs. These medications reduce inflammation which contributes to the pain one feels and are often the drug of choice for joint pain. These medications are not to be taken without caution as they may increase the potential for bleeding of the GI tract, kidney damage, heart attack, and stroke even in low doses when taken frequently. Take these medications with food to prevent gastric irritation and stomach pain. Follow instructions for dosage included with the product closely.
Tips
Read labels and understand what is in the product.  If you don't understand ask a physician, pharmacist or other healthcare professional.
Adults should Limit Tylenol to 4000 mg/24 hr, 3250 mg/24 hr or less if you use alcohol or take medications affecting the liver.
Take medications with only single ingredients unless the other ingredient will also help your symptoms.  Tylenol PM contains Tylenol and Benadryl. If experiencing insomnia without pain just take the Benadryl.
Breast feeding mothers should avoid aspirin or salicylates due to potential risk of Reye's syndrome. Acetaminophen and ibuprofen have the most safety data. Pregnant females should also avoid aspirin.
Patients taking "blood thinners"(warfarin/Coumadin) should avoid aspirin products as they increase "thinning" of the blood.
If your physician has you taking aspirin for its cardio protective effect, discuss with him/her or your pharmacist the timing of any NSAID's you may be taking to provide for the greatest potential benefit.
Discuss with your physician or pharmacist any potential drug interactions between your OTC pain relievers and your other medications.