What's Best for My Pain: Tylenol or Advil?

New York Times

27-05-2025

Q: I never know which type of over-the-counter pain medication to use for different types of pain, like headaches, sprained ankles or sore muscles. Which works best for these unique situations?
When you have various aches and pains, it can be challenging to decide which over-the-counter pain reliever is best matched for your affliction — Advil, Aleve, Tylenol, Motrin?
The choice, experts say, really comes down to just two classes of medication: acetaminophen and nonsteroidal anti-inflammatory drugs (or NSAIDs).
Each addresses pain in its own way, said Mary Lynn McPherson, a professor at the University of Maryland School of Pharmacy. And not all types of pain respond equally well to both, she added.
Here's how to tell what types of pain these drugs are most effective at relieving, and how to use them safely.
How They Work
NSAIDs, which include ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin (Bayer), help relieve pain by rushing to sites of inflammation throughout the body, said Dr. Katherin Peperzak, medical director of the Center for Pain Relief at the University of Washington Medical Center.
They reduce or block two enzymes (called COX-1 and COX-2). This action hinders the production of prostaglandins, chemicals that contribute to swelling, inflammation and pain, Dr. Peperzak said.
Acetaminophen (Tylenol), on the other hand, is dispatched to receptors in the brain and the spinal cord, but what it does from there is a little more mysterious. 'We're not 100 percent sure how the heck that bad boy works,' Dr. McPherson said.
One theory is that it also reduces certain COX enzymes, Dr. Peperzak said. But acetaminophen doesn't target inflammation like NSAIDs do, Dr. McPherson added.
When to Use Them
Acetaminophen and NSAIDs can relieve many of the same types of pain. But there are pros and cons to each.
NSAIDS are best at treating inflammation-related pain that occurs anywhere in the body, whether it's localized to one spot (as with migraine headaches, toothaches, muscle strains or cuts) or spread throughout (as with arthritis pain).
'If you've got redness, heat, swelling, or it's an acute injury, there's probably some inflammation,' Dr. Peperzak said, and your pain is a good candidate for NSAIDs.
All NSAIDs work similarly, so choose the one that's most effective for you, said Dr. F. Michael Ferrante, director of the Pain Management Center at the University of California, Los Angeles.
Naproxen (sold as Aleve), however, does tend to keep pain away for longer than the other NSAIDs — about 12 hours, Dr. McPherson said. Ibuprofen (Advil, Motrin), on the other hand, works for closer to four to six hours.
Acetaminophen (Tylenol) is most effective for more mild pain that is not caused by inflammation, Dr. Peperzak said. It can help with mild arthritis pain or tension headaches, for example, Dr. McPherson said — or body aches related to a cold, Dr. Peperzak added. It's less helpful for migraine headaches or menstrual pain, she said. Unlike NSAIDs, acetaminophen won't treat symptoms of inflammation like swelling or redness, Dr. McPherson said, which could cause the body to take longer to heal.
Both classes of drugs can help reduce a fever, Dr. Ferrante said.
Using Them Safely
Unless your doctor recommends otherwise, it's best to follow the product's dosing guidelines, Dr. Ferrante said. For adults, that's typically no more than 3,000 milligrams of acetaminophen per day, he said — and up to 1,200 milligrams per day for ibuprofen, 660 milligrams for naproxen and 4,000 milligrams for aspirin.
Acetaminophen and NSAIDs can be taken together, either at the same time or by alternating them throughout the day. This lets you 'benefit from both mechanisms,' since they work differently for pain relief, especially if you aren't getting results from one alone, Dr. Peperzak said.
However, avoid doing this with individual categories of NSAIDs (by mixing ibuprofen with naproxen, for example). Using too much at once or for long periods of time increases the risk of developing chronic acid reflux, nausea, ulcers or kidney problems, Dr. Ferrante said. It also increases the risk of heart attack, stroke and high blood pressure, Dr. McPherson added.
Certain people — such as those who are pregnant or breastfeeding, are taking blood thinners or have a history of high blood pressure or kidney, liver or heart disease — should avoid NSAIDs (or at least consult a doctor first), Dr. McPherson said.
Acetaminophen is less likely to cause side effects, Dr. Peperzak said. Minor ones may include a rash, nausea or constipation. But acetaminophen can be toxic to your liver when taken at high doses, Dr. McPherson said, so avoid it if you have a history of alcoholism or liver disease.
If you need to use any of these drugs for more than a few days, consult a doctor, who may recommend prescription-strength versions of the medications or other pain treatments.
And if you aren't sure which drug to take in the first place, a doctor or a pharmacist can help recommend a medication based on your specific needs, Dr. McPherson said.