What to take for that ache
"Oh, my aching back!"
"I have a splitting headache."
"Ouch! It's that old ankle sprain acting up again."

For quick relief from aches or pains, what do you do? More than likely, you take a pain reliever like aspirin, Aleve^®, Tylenol^® — whatever's handy. After all, a pain killer is a pain killer, right?

Wrong. All pain medications are not alike, and it's important to understand the differences. In the long run, the misuse, mixing, or overuse of nonprescription medicines could do you more harm than good. For example, did you know you should never give children under the age of 12 aspirin because of the risk of Reye's Syndrome? Aspirin: that most common of medications.

Two types of pain-killers
Meet the "Coxes"
About those side effects...
Meds and kids
Use caution, common sense, and your reading skills

Two types of over-the-counter pain-killers
Over-the-counter pain relievers and fever reducers are grouped into two basic types — those that contain acetaminophen, and those that contain nonsteroidal anti-inflammatory drugs, or NSAIDs.

• Acetaminophen is a common pain reliever and fever reducer. Tylenol and other drugs containing acetaminophen are used to relieve headaches, muscle aches, and fever. Some cough syrups and cold and sinus medications also contain acetaminophen.
• NSAIDs are used to help relieve pain and reduce fever. This group includes aspirin and drugs containing ibuprofen or naproxen, such as Advil^®, Aleve^®, and Motrin^®. NSAIDs are also found in medications for colds, sinus pressure, and allergies. Aspirin offers an extra benefit: it can inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk — but it carries risks, too, as explained in the next section.

Meet the "Coxes"
You may have heard about drugs called Cox-1 or Cox-2 inhibitors. To keep things from getting too complicated, here's a brief introduction to the Cox enzymes, drawn from information at www.medicinenet.com:

Cox-1 is cyclooxygenase-1, an enzyme that's normally present in various areas of the body, including sites of inflammation and the stomach. Cox-1 of the stomach produces "chemical messengers" called prostaglandins, which help preserve the natural, protective lining of the inner stomach. When an anti-inflammatory drug blocks Cox-1, it helps reduce inflammation, but it also reduces the protective lining of the stomach — an effect that can cause stomach upset, ulceration, and bleeding from the stomach and intestines.

Cox-2, or cyclooxygenase-2, is a similar enzyme, but it isn't in the stomach; it's in areas of the body that are responsible for inflammation. So when an anti-inflammatory drug blocks Cox-2, it reduces inflammation but doesn't risk injuring the stomach or intestines.

The common anti-inflammatory drugs (aspirin, ibuprofen, and naproxen) all act by blocking the action of the Cox-1 and Cox-2 enzymes. But the newer Cox-2 inhibitors selectively block only Cox-2 - which means they help reduce inflammation without irritating the stomach. The best of both worlds? So it seemed, until reports began to surface about Vioxx^®, Celebrex^®, and other Cox-2 inhibitors.

About those side effects...
You've heard the disclaimers on TV commercials — those long, scary lists of possible side effects. The fact is all over-the-counter drugs have been approved by the FDA as safe and effective for use without a doctor's prescription. But that doesn't mean you can throw caution to the wind. Be aware of the risks:

Researchers say NSAIDs are a leading cause of stomach ulcers and can have side effects ranging from an upset stomach to potentially life-threatening stomach bleeding, according to a WebMD Special Feature Section. NSAID use and misuse leads to more than 103,000 hospitalizations and 16,500 deaths each year in the United States. Acetaminophen isn't 100 percent safe, either. Taking more than the recommended dose of acetaminophen can cause liver damage.

As the WebMD article points out, taking any of these medications long-term and without your doctor's knowledge greatly increases the chance of a complication — even a potentially life-threatening problem. So talk with your doctor first, and be aware of the risks:

• Allergies and asthma
  If you're allergic to NSAIDs, you could develop shortness of breath when taking one. Anyone with a serious allergy to one of these anti-inflammatory drugs is likely to experience a similar reaction to another. If you have asthma, you're at a higher risk for having a serious allergic reaction to NSAIDs.
• Ulcers and stomach bleeding
  NSAIDs can increase your risk for stomach bleeding, especially if:
  • You're over 60 years of age
  • You're taking prescription blood thinners
  • You've had stomach ulcers in the past
  • You have other bleeding problems
• Aspirin has risks, too
  Since aspirin is an NSAID, it can irritate the stomach lining, causing bleeding or ulcers. If aspirin upsets your stomach, try a coated brand like Ecotrin^®.
  
  Talk with your doctor or pharmacist to determine what will work best for you. In children and teenagers, especially those with suspected or confirmed chicken pox or influenza, aspirin has been associated with the development of Reye's Syndrome.
  
  Other precautions to keep in mind before taking aspirin:
  
  • Don't take aspirin for a hangover. The combination of aspirin and alcohol increases your risk for stomach irritation.
  • High doses may result in aspirin poisoning (salicylism). Stop taking aspirin and call a health professional if you have any unusual symptoms like ringing in the ears, visual disturbances, nausea, dizziness, or rapid, deep breathing.
  • Don't take aspirin if you have gout or take blood thinners (anticoagulants).
  • If you're pregnant, check with your doctor or pharmacist before taking aspirin.

The best rule to follow before taking a non-prescription pain reliever — or any over-the-counter drug, for that matter — is to check with your doctor first.

Meds and kids
Kids have aches, pains, and fevers, too. But just because a child is half your size doesn't mean you should give her half of the adult dose of a medicine. Take these tips from the FDA:

• Don't estimate the dose based on the child's size.
• Read the label and follow all directions.
• Follow any age limits stated on the label.
• Some over-the-counter products come in different strengths. Be aware of the strength of the medication before administering it.
• Know the difference between TBSP (tablespoon) and TSP (teaspoon) — they're very different doses.
• Be careful about converting dose instructions. If the label says two teaspoons, use a measuring spoon or dosing cup marked in teaspoons — not a kitchen spoon.
• Don't play doctor. Don't double the dose just because your child seems sicker than last time.
• Before giving your child two medicines at the same time, talk to your doctor or pharmacist.
• Never let children take medicine by themselves.
• Never call medicine "candy" to get your kids to take it. If they come across the medicine on their own, they're likely to remember you called it candy.

Use caution, common sense, and your reading skills
Even if you don't have a medical condition that increases your chances of a serious drug reaction, side effects are always possible. The possibility becomes a probability if you misuse or overuse the medication.

Be cautious. Read the labels of all your over-the-counter medications carefully and use them as directed. If your doctor's advice is not the same as the label direction, follow doctor's orders. And remember this practical advice from the FDA: before using any medicine, think "SAFER":

• Speak up
• Ask questions
• Find the facts
• Evaluate your choices
• Read the label

A good way to find the facts and evaluate your choices is to visit the FDA's Website, www.fda.gov, or go to MyHumana at www.humana.com, where you can browse the drug library and get e-coupons for savings on popular over-the-counter medications.

Bottom Line:
Because they're so common, most of us take pain relievers for granted. Don't. They're serious medication that can have serious side-effects. Take the time to read the label, and talk to your doctor about the potential benefits and risks before taking any medication.

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