Tylenol Or Advil? Not Created Equal For Pain Relief


As we move merrily along into our so-called midlife, it’s not uncommon to feel pesky, everyday aches and pains from things like headaches, back pain, arthritis, sciatica the list goes on. Because I exercise pretty frequently, it’s not unusual for me to feel pain from time to time (yes, I’ll admit pushing myself beyond my reasonable limits every once in a while!). Granted, I can’t always blame exercise although I hate to use the age card to start complaining so I won’t.

One of my most recent and pleasant discoveries for pain management has been self-massage for various aches and pains; my favorite thing to use is a hand-held massager, like these made by Wahl. But that’s not always the only remedy. My medicine cabinet is filled with different over-the-counter pain relievers, among them Tylenol and Advil. And I usually reach for one or the other with no thought given as to why I’m taking that particular one, other than the fact I can no longer stand the pain I’m feeling, or I’ve run out of one or the other.

Which is why a recent article in the Wall Street Journal caught my eye: It’s about how all over-the-counter pain relievers do not work interchangeably; apparently they work differently in your body, and they can have different side effects. What’s good for a headache is not necessarily good for achy knees.

The article says: “Got a headache? Tylenol, or its generic version acetaminophen, might be your best bet since it comes with fewer side effects, many experts say. Inflamed elbow? Advil, whose active ingredient is ibuprofen, is likely to bring greater relief. And if you’re trying to bring down a fever, either medication will probably work, although some studies have found Advil to have a slight edge.”

Who knew?

Curious, I scoured the Internet for more info. And sure enough, you need to be selective when choosing which to take for what ailment. The Cleveland Clinic pitted acetaminophen (Tylenol) against ibuprofen (Advil). They reported that Tylenol works better for things like headaches and arthritis, while you’re better off with Advil for things like fever, pain and inflammation.

Which Pain Reliever Is Right for You?

An aspirin may help your nagging headache, but will it reduce a fever, soothe a toothache, alleviate back spasms or reduce knee swelling? Not all over-the-counter (OTC) pain medications, including aspirin, are created equal, according to Samuel Weiner, MD, a Virtua family physician.

“It can get confusing with the number of brands available on the market,” says Dr. Weiner, “but there are only four major over-the-counter pain-killing products – aspirin, acetaminophen, ibuprofen and naproxen. Each has a different overall effect on the body.”


Acetaminophen is a pain reliever and fever reducer. Unlike the three other primary OTC pain medications, acetaminophen does not contain anti-inflammatory properties.

Conditions treated:

  • Arthritis pain
  • Back pain
  • Body aches associated with cold or flu
  • Fever
  • Muscle aches
  • Sore throat
  • Toothaches

Check with your doctor if you have:

  • History of alcoholism
  • Liver problems

“Many over-the-counter products for cough, colds and flu contain acetaminophen, which is great at reducing fevers,” says Dr. Weiner. “But you should look at the ingredients on these multi-symptom products. If they contain Tylenol, you should include that as part of a daily limit. The U.S. Food and Drug Administration (FDA) recommends 4,000mg as the maximum daily dose of acetaminophen for adults.”


(Aspirin is often used as an analgesic (pain reducer) to relieve the body of pain, fever and inflammation. It is also used as a blood thinner and may treat or prevent heart attacks and strokes. Some individuals take low-dose aspirin to help ward off heart disease.

Conditions treated:

Check with your doctor if you have:

  • Blood disorder
  • Asthma or any other allergic disorder
  • Stomach ulcer
  • Liver or kidney problems

“Aspirin can be an effective pain reliever, but it should only be used for treatment or prevention of cardiovascular conditions under the supervision of a physician,” says Dr. Weiner.


Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). It reduces hormones that cause inflammation and pain in the body and is used primarily for mild to moderate pain, fever and inflammation.

Conditions treated:

  • Arthritis
  • Backache
  • Bee stings
  • Headaches
  • Inflammation
  • Menstrual cramps
  • Minor injuries
  • Muscle aches
  • Toothache

Check with your doctor if you have:

  • Asthma
  • Heart disease
  • High blood pressure
  • Kidney problems
  • Liver problems
  • Stomach ulcer

“We use ibuprofen a lot for musculoskeletal injuries such as sprains and strains,” says Dr. Weiner.


Naproxen is also an NSAID. It typically has a more prolonged effect compared to ibuprofen. Naproxen is commonly used to relieve a higher level of pain, swelling and stiffness.

Conditions treated:

  • Arthritis
  • Gout pain
  • Fever
  • Inflammation
  • Kidney stone pain
  • Menstrual cramps
  • Migraine
  • Sprains/strains
  • Tendinitis

Check with your doctor if you have:

  • Asthma
  • Bleeding or blood clotting disorder
  • Heart disease
  • History of heart attack or stroke
  • Kidney disease
  • Liver disease

“Naproxen is more potent than ibuprofen and lasts twice as long,” says Dr. Weiner. “Although naproxen may have a more potent effect than ibuprofen, it may also have more gastrointestinal side effects.”

What about generics?

Can most individuals tell the difference between a name brand OTC medication and a generic version? Does the name brand work better than the generic one? According to Dr. Weiner, it is a “no” to both questions. The FDA requires that generic OTC medications include the exact same active ingredients found in name brands. Generics cost less than brand-name equivalents because the latter are backed by huge (and expensive) promotional campaigns and investments in research and development.

“I encourage my patients to look for generics,” says Dr. Weiner. “Generic over-the-counter pain relievers are less expensive, and they are just as effective as the name brands.”

Although both medications are considered to be safe, the word “safe” has some caveats:

They can be toxic.

Taking too much Tylenol can be damaging to your liver (and it may be permanent). Prolonged use of Advil can lead to kidney damage, heart attack and stroke.

They can have side effects:

Tylenol’s side effects are minimal, although it can, on rare occasions, cause potentially fatal skin reactions. Advil may give you severe stomach bleeding (as in ulcers), heartburn, gastrointestinal upset and/or constipation.

And it’s important to know a few other facts:

  • Acetaminophen (Tylenol)

Acetaminophen (Tylenol) is present in over 150 other products, including those used to treat coughs and colds, allergies, pain and sleep disturbances; always check labels for acetaminophen or APAP to avoid overdose. The new daily limit is 3,250 mg. of acetaminophen that’s equivalent to 10 regular or six extra-strength pills each day. If acetaminophen is present in multi-symptom products you take, include that amount in your daily total. And you should not take it if you have three or more alcoholic drinks a day.

  • Ibuprofen (Advil)

Ibuprofen (Advil) should be avoided before and after heart surgery and should not be used if you have an allergy to aspirin, naproxen (Aleve) or other NSAIDs (non-steroidal anti-inflammatory drugs, like Motrin). The risk of bleeding is increased for those over age 60 and for people with ulcers. Be cautious, too, if you take steroids, blood thinners or other NSAIDs, or consume more than three alcoholic beverages a day.

If you need an analgesic often (like for treating a high fever or chronic pain), experts advise alternating dosesof Tylenol and Advil, which can minimize side effects while providing greater relief. And of course, if you experience any type of allergic reaction, stop taking the medication and seek immediate help.

An interesting aside:

Two recent studies found that along with dulling your physical pain, acetaminophen might also dull your responses to emotional pain. If all this information is deterring you, there are also other things you can do to treat pain. The American Pain Foundation lists some herbs for pain management

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