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Medical Summaries
Drugs for Pain

Pain Killers Comparison Chart
Painkiller Summary
by Vaughn Aubuchon

What are the best pain pills? What are the dosages?
Which pain killers have the worst side-effects?
This chart lists the pain relief ability of the most common pain medication, for both OTC and prescription.




1. Over-the-counter (OTC) -- 2. Prescription

Here is a comparison table summary of popular pain medication. The pain relievers below were ranked by effectiveness for chronic back pain, by a Harvard Study. Each pain medication was rated for effectiveness on a scale of from 1 (aspirin) to 10 (morphine).
Disclaimer

30

100

60

30

80

80

30

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Painkiller Comparison Chart
From Weakest to Strongest

.

   1. OVER - THE - COUNTER (OTC) Pain Medicine

Brand Name
(Capitalized)
generic name
(not capitalized)
Dose
(per pill)
PAIN
RELIEF
SCORE
Uses According
to Label
Best Uses
(according to
Consumer's Guide)
Problems
Caused

Anacin
Bayer
Bufferin
Ecotrin

aspirin
(acetylsalicylic acid)
NSAID
81 mg
325 mg
1

Minor aches, pains
cold, headache,
muscular ache

minor aches and pains

aspirin allergy,
asthma,
stomach bleeding,
Reye's Syndrome

Anacin non
Excedrin
Tylenol

acetaminophen
(N-(4-hydroxyphenyl)
acetamide)
L374 caplet
500 mg
2

Headache

fever,
if allergic to aspirin,
arthritis,
rheumatism,
musculo-skeletal

June 2009, again
7-04-06-
Tylenol Liver Damage
"Tylenol is the No. 1 cause of acute liver failure in the U.S."
"[Acetaminophen] is a leading cause of death from pharmaceuticals,"

Vanquish

Combination of
aspirin (NSAID), and acetaminophen
325 mg
500 mg
2.25

Headache
Muscle ache

headache

same as above
not for children and teens

Advil
Motrin
Nuprin

ibuprofen
(2-(4-Isobutyl-phenyl)-
propionic acid)
(analgesic, antipyretic)
NSAID
44 291 tablet
200 mg
2.5

Aches, pains,
colds, toothache,
muscle aches,
backache,
menstrual, fever

fever,
muscle ache

aspirin allergy,
asthma,
upset stomach,
not for last trimester

Aleve
Naproxen

naproxen sodium
(anti-inflammatory)
NSAID
220 mg
3

Joint and muscle pain

arthritis,
rheumatism,
musculo-skeletal

Naproxen heart risk
upset stomach,
not for nursing mothers

Motrin 800

ibuprofen
(analgesic, antipyretic)
NSAID
800 mg
3.5

(listed above)

(as above)

(as above)

Actron
Orudis

ketoprofen
(anti-inflammatory)
NSAID
12.5 mg
3.6?

Anti-inflammatory,
analgesic

arthritis

Ketoprofen side effects

Notes :

(NSAID= Non-Steroidal Anti-Inflamatory Drug)
More Warnings on OTC Drugs:
NSAIDS Increase Blood Pressure
Aspirin and NSAIDS Cause Stomach Bleeding Resulting In Death
NSAIDS Linked to Erectile Disfunction

90

170 - 700

60

40

90

90

160


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Epidemic of Lethal Overdoses
from Prescription Painkillers
from the CDC - Nov. 1, 2011

.

   2. PRESCRIPTION Pain Medicine

Brand Name
generic name
Dose
(per pill)
PAIN
RELIEF
SCORE
Uses According
to Label
Problems
Caused

Celebrex

celecoxib
(COX-2 inhibitor)
NSAID
100 mg
200 mg
3.7*

Osteoarthritis,
rheumatoid arthritis,
short term pain,
painful menstruation

Celebrex heart risk
stomach bleeding,
heart attack, stroke

Ultram

tramadol
50 mg
3.8*

Moderate pain

nausea, constipation, dizziness, headache, drowsiness, vomiting

* Note: The scores for Celebrex and Ultram are estimates (3.7* and 3.8*). These two drugs did not exist at the time of the study.

Demerol

meperidine HCl

50 mg
100 mg

4

The opiates and synthetic opiates (from 4 down to 10) are the most effective pain killers, but they are subject to the most abuse, and prescription pain killer addiction. All the opiates and derivatives are habit-forming.

The inclusion of high amounts of acetaminophen (Tylenol) with all these medications is a rather CRUEL attempt by the pharmaceutical companies to prevent abuse, since overdosing will result in the destruction of the liver. I would describe this, at best, as "not very nice". The Puritanical ethic at work, destroying livers, and lives. "Let's kill off all the druggies." This is way beyond cynical.

Knowing that these drugs are abused, and then filling them up with the poisonous acetaminophen, is criminal malfeasance by the drug companies. One more reason to prosecute them.

Fed Seeks Less Acetaminophen in Combo Pain Pills - Jan. 13, 2011
FINALLY!


** The score for Norco is an estimate. It did not exist at the time of the study.

Lorcet

hydrocodone and
acetaminophen

5-500 mg

5

Vicodin

hydrocodone and
acetaminophen

5-500 mg

5

Lorcet Plus

hydrocodone and
acetaminophen

7.5-650 mg

5.5

Vicodin ES

hydrocodone and
acetaminophen

7.5-750 mg

6

Norco

hydrocodone-APAP,
and acetaminophen

5-325 mg
7.5-325 mg
10-325 mg

6.5**

Lortab

hydrocodone and
acetaminophen

10-500 mg

7

Vicodin HP

hydrocodone and
acetaminophen

10-660 mg

7

Percocet

oxycodone HCl with acetaminophen

2.5-325 mg
5- 325 mg
7.5-325 mg
7.5-500 mg
10-325 mg
10-650 mg

7

Oxycodone is very effective.

** The score for oxycodone is an estimate. It did not exist at the time of the study.

Percodan

oxycodone HCl,
oxycodone terephthalate,
and aspirin

4.50 mg
0.38 mg
325 mg

7

Oxycontin 40

oxycodone HCl
40 mg
8.5

RMS
MS Contin

morphine sulfate
15 mg
30 mg
60 mg
100 mg
9

Morphine may be the fourth strongest pain relief medicine available.

Duragesic
Fentora
Actiq

fentanyl
Skin patch

Lollipop
10

** The score for fentanyl is an estimate. It did not exist at the time of the study. Fentanyl is very effective for gunshot wounds, and fragmentation wounds. However, there have been serious problems with fentanyl dosing (overdosing). Death has resulted from simply handling the medication with the fingers. One must use great care when handling fentanyl.

Dilaudid (tabs)
Palladone
(caps)

hydromorphone
hydrochloride
AKA
dihydromorphinone
1 mg
2 mg
3 mg
4 mg
11
(was 9)

I recently received a very thoughtful email from a Special Operations medic. He stated that he has extensively administered all of these top medications. He concludes that Dilaudid is several times more effective than morphine, and that it has fewer side effects, although just as serious. I have therefore moved Dilaudid to the "most-effective drug" position on the list.

Opana


Opana ER

oxymorphone


extended release
5 mg
10 mg

5 mg
7.5 mg
10 mg
15 mg
20 mg
30 mg
40 mg
?

3 hours (also, injection and suppository)


5 - 8 hours

90

170 - 700

90

40

140

170

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DISCLAIMER
The author has no medical training. No advice is intended.
Consult your doctor for personal pain reliever advice.

Although the author has tried to be as accurate as possible, errors and misstatements are possible. Some pain medicine was not available at the time of the study, such as tramadol (Ultram), celebrex, etc.
This data was summarized and ordered by me into this Pain Killer Chart, primarily from
http://neuro-www.mgh.harvard.edu/forum_2/ChronicPainF/3.19.991.15AM PAINKILLERS SU.html and from other Pain Medication websites. The Harvard study was based upon the best painkiller for chronic back pain relief. This is a Pain Meds Comparison Chart. It compares each prescription pain drug, and each OTC pain drug.
I made this Painkiller Summary/ Pain Medication Table to identify the best pain relief alternatives, and to point out the side effects of each one.

IRONY - Acetaminophen seems to be the "baddest boy" on the block. Not only is it marginally effective, it doesn't take much to destroy your liver. Least effective, most dangerous. Great.

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DISCLAIMER ADDENDUM (July 13, 2010):
Due to an email from Ron K., I have undertaken the task to write a more comprehensive disclaimer, emphasizing that this page consists of very subjective estimates. I , too, have pondered the dosage issue of one medication versus another. Which dosage of a medication is comparable to which dosage of another similar medication?

I had made the assumption that the comparisons above are based upon the median dosage of one medication, versus the median dosage of another medication. I have BOLDED the "median/ popular" dosages. Is this the best way to do this?  I don't know. But it is a simplified way to do it.

To try to compare every single dosage of each medicine, with every other, the number of substance/ dosage combinations versus all the other substance/ dosage combinations, would be impractical for several reasons -
1. The number of comparison combinations is prohibitive, if all are done.
2. Which comparisons are to be made? Certainly not aspirin versus morphine. Perhaps each substance/dosage should be compared with the two adjacent substances?
3. Where is this data to come from? To have accurate comparisons of each medicine/ dosage versus every other medicine/ dosage would be great! But I have no idea how you would get them, other than creating a massive tightly-controlled survey of users.
4. Just how accurate would this data be, since the nature of the data is so subjective. One person might say that "4mg of X makes me feel better than 10mg of Y", and another person might say just the opposite. Who is correct?
5. All patients are different - their pain is different, their tolerance to pain is different, and their response to medications is different. I weigh over 300 lbs. It takes a lot more of just about ANYTHING to affect me. Doctors frequently fail to recognize or concede this "dilution factor". Also, a very slight person receives a "concentration factor", which can be a far worse situation.
6. Due to the different ways that the medicines work, I don't think that mg vs. mg comparisons are directly comparable. Doubling the dosage of one agent, can be profoundly different than doubling the dosage of another. Some medications concentrate in certain organs, while others distribute themselves throughout the blood volume.

So, who is going to set the "Approximate Equivalent Dose"? The pharma company? NO way. We know how full-of-it they are. Reference the current Avandia data suppression. And the vested interests - manufacturer vs. manufacturer. Who else is going to do it? No one can scientifically do this, as far as I know. "Pain-relieving-effect" is very hard to judge, and describe.

I have read many pharma company descriptions of effectiveness and side-effects. I will take anecdotal evidence over "official pronouncements" any day. Doctors parrot the text put out by the pharma companies as if it were irrefutable fact, and poo-poo "personal stories" as biased and inaccurate. Balderdash! Personal anecdotes describe what is REALLY going on with REAL people. I prefer to listen to the mouths of patients, rather than the biased sellers of the medicines.

All the pain relief scores on this page are SUBJECTIVE ESTIMATES, and may not reflect reality for every patient. Or even come close. I wish I knew how to make this page better, other than just an expanded disclaimer.



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This Vaughns Best Pain Killer Summary Chart
was last updated on 2014-04-21.