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Pain relief primer

When kissing it better isn't enough

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Originally published in Today's Parent February 2006

Infant drops, junior syrups, chewables, adult tablets, generic versus brand — who knew picking over-the-counter medications for easing aches could be such a…pain? If you’re confused about which product to choose, we’ve got some answers.

Q. Which is better: acetaminophen or ibuprofen?

A. Doctors are just as much in the dark on this question as parents, says Ran Goldman, a specialist in paediatric emergency medicine and clinical pharmacology and toxicology at Toronto’s Hospital for Sick Children. When Goldman recently reviewed 13 studies comparing the two medications, he found: “None came to a final conclusion on which one is better.” Both medications are effective for easing mild to moderate pain and reducing fever.

That said, each drug works differently and has qualities that may make it a better choice in certain cases.

Q. So what are some factors to consider when selecting one drug over the other?

A. Acetaminophen (Tempra, Tylenol, Panadol) may be safer for treating illnesses involving severe vomiting, or vomiting and diarrhea, because in rare cases ibuprofen can cause kidney injury in dehydrated kids. And when even a few sips of water won’t stay in your toddler’s tummy, acetaminophen is the only over-the-counter (OTC) pain reliever available in rectal suppositories. Acetaminophen is also less likely to cause side effects than ibuprofen medications.

Ibuprofen (Advil, Motrin) may be better at treating conditions involving inflamed, swollen tissues, such as sunburn, menstrual cramps and muscle sprains. Unlike acetaminophen, ibuprofen actually reduces chemical signals that drive both inflammation and pain. Ibuprofen also provides longer-lasting relief — six to eight hours, versus four to six for acetaminophen.

However, ibuprofen carries a higher risk of side effects than acetaminophen: It can irritate the stomach and trigger attacks in a very small percentage of kids with asthma. In rare cases, ibuprofen may also be associated with a serious skin reaction called Stevens Johnson syndrome (more on this later).

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