By Dr. Katie E. Golden, MD

As the country recovers from the decades-long opioid crisis, many people are left wondering how to treat their pain without prescription pain medication. Opioids have earned their reputation for being dangerous, but not necessarily their reputation for being effective. 

The truth is that over-the-counter pain medication can be just as strong, with significantly less risks and side effects. And many of the most effective pain treatments don’t involve medication at all. So whether you live with pain every day, or are dealing with a temporary illness or injury, let’s walk through your options.


NSAIDs stands for non-steroidal anti-inflammatory drugs. They are a class of medications that include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Aspirin

These medications are great at treating pain, especially when it comes from inflammation in the body. This means they can be particularly useful for:

  • Muscle injury or strain
  • Back pain
  • Joint pain and arthritis
  • Pain from infections, like a sore throat or skin infection

Even though they are over-the-counter, they still come with a few risks and side effects that are important to know. NSAIDs can lead to:

  • Gastroesophageal reflux disease (GERD), commonly referred to as heartburn.
  • Stomach ulcers, which can lead to gastrointestinal bleeding.
  • Kidney damage, especially in people with underlying kidney problems.
  • Increased risk of cardiovascular disease — like heart attack and stroke. 

NSAIDs are less likely to lead to any of the above problems in small, infrequent doses. But if you have a history of heart disease, stroke, kidney disease, or other blood vessel conditions like high blood pressure, there may be safer options. 


Acetaminophen is best known by its brand name, tylenol. It works differently than NSAIDs, though it can treat similar types of pain. In addition to relieving muscle and joint pain, it is often people’s go-to for headaches as well. 

And because it is different from NSAIDs, it can be particularly effective to combine these two medications. You can take both Tylenol and an NSAID on the same day for maximal pain relief. Some people prefer to take a dose of both medicines at the same time. Other people find it more effective to stagger the doses, alternating tylenol and NSAIDs every 3 to 4 hours.

Tylenol is a safer option if you have a history of kidney disease or stomach problems. The main risk with tylenol is liver damage — although this is unlikely if you stick to the recommended dosages. Still, anyone with underlying liver disease should avoid tylenol unless recommended by their provider.

Topical Analgesics

If you want to avoid many of the side effects associated with pills, then creams, gels, and patches are a great choice. They target the area of pain, while having minimal effect on the rest of the body. This makes them particularly good for muscle or joint pain in a specific area.

There are a few different over the counter options:

  • Diclofenac gel (Voltaren): Diclofenac is an NSAID. There are several different topical versions, but the over-the-counter version comes in a 1% gel. It is particularly good at treating arthritis pain.
  • Lidocaine patches (Lidoderm): Lidocaine is a numbing medication, like the kind you get for dental work or stitches. It comes in over-the-counter patches that can be applied directly to the area causing pain, like the lower back.
  • Capsaicin creams: The active ingredient in capsaicin actually comes from chili peppers. It interferes with a chemical that plays a role in pain sensation. The cream is particularly effective for nerve-related pain. 
  • Menthol creams: Many people recognize these creams by their peppermint smell. It creates a cooling effect on the skin that dulls the pain. It is typically found in combination creams that include other pain medication, like camphor and salicylic acid (the active ingredient in aspirin). Common examples are Bengay and Icy Hot.
  • CBD creams: More and more people are turning to CBD (cannabidiol) for pain relief. CBD is a molecule found in the marijuana plant, but it’s not the molecule that gets you high (THC). Scientists are still trying to understand its therapeutic uses in humans, but evidence suggests it is an effective and relatively safe way to relieve pain.

Any topical pain medication has the potential to cause skin irritation. And when you apply it to your skin, some of the medication can still be absorbed into the bloodstream. So it’s best not to slather on large amounts over large areas of skin. This way you can avoid any adverse effects — and smelling like a walking peppermint for days.

Non-medication treatments

Pain medications are effective in the way they target the chemicals and nerves that cause pain. But they also take advantage of the psychological effect that comes with taking a pill or rubbing on a cream. When our brain believes something will help, it usually will.

But it’s easy to forget that there are many treatments for pain that have nothing to do with medication. And the research shows that many of these treatments provide stronger, longer-lasting effects than medications. So the next time you are experiencing pain, consider one of these options:

  • Physical movement: This does not necessarily need to be intense exercise. Gentle stretching, walking, yoga, and especially swimming can have powerful effects on pain and overall health. And of course, physical therapy is becoming first line treatment for many different types of short and long term pain.
  • Hydrotherapy: People have been tapping into the therapeutic effects of water for centuries. And while cold water plunges are gaining traction as an alternative treatment for a number of ailments, you don’t need to do a polar bear plunge to experience the benefits. Saunas and warm baths are great, more relaxing options.
  • Body work: Lay down and let someone else do the work for you. There are many different types of massage therapy depending on the type and location of your pain. Acupuncture is also becoming an increasingly popular treatment for a wide variety of different health conditions, including pain. 
  • Therapy: Let’s get back to the power of the mind. The sensation of pain starts and ends with the nervous system. So changing your body’s response and interpretation of pain can be a powerful way to reduce pain. This can be anything from cognitive behavioral therapy, to biofeedback therapy, to breathing and relaxation techniques.

It’s admittedly easier to reach for a dose of tylenol instead of signing up for a yoga class or scheduling an appointment with a therapist. (A massage or a sauna session may be an easier sell.) No matter which of the above options you try, approach it with the mindset that it is medicine. Without the bitter taste or minty smell.