NSAIDs have also been linked to kidney injury in older adults, “which is something I really worry about, too,” Thompson says. “As we age, we really depend on [lipids in the body called] prostaglandins to keep the blood flow to our kidneys. And the way [NSAIDs] work is they inhibit those prostaglandins,” causing the blood vessels to constrict, which can result in kidney injury.
Finally: NSAIDs carry the risk of potential skin reactions, the FDA warns. Patients should be on the lookout for symptoms of skin reddening, rash or blisters.
"So you really want to leave [NSAIDs] as kind of your last choice, which is interesting, because most people go to these first. But when you're over 50, this one needs to start moving down the list, versus something like a Tylenol,” Garling says.
What to Know About Aspirin
Aspirin is an NSAID, but it's generally not recommended for pain relief in older adults because it can cause bleeding in the stomach and the brain — and the bleeding risk increases with age. Plus, other OTC remedies are more effective at mitigating pain, both Garling and Thompson say.
Where aspirin can come in handy is as a preventive therapy for people who have cardiovascular disease or who have already had a heart attack or stroke. Regular use can reduce risks of another cardiovascular event by keeping the blood from clotting and increasing blood flow to the heart and brain. It is not recommended to prevent first-time heart problems and is often misused as such.
Always check with your health care provider before starting aspirin therapy to weigh the benefits and the risks and to make sure any OTC and prescription medications you're taking are OK alongside aspirin — otherwise “you could be doing your body more harm than good,” the FDA says.
Topical pain relievers
Not all pain relievers come in a pill. Topical medications — gels, creams, patches and sprays — can be effective at targeting pain, especially local pain in muscles and joints. Plus, if you're worried about side effects from pills, topical pain relievers carry less of a risk “because there's less systemic absorption,” Thompson says.
- Topical NSAIDs: Some OTC creams contain NSAIDs, including diclofenac sodium (brand name, Voltaren), which is a popular and effective medicine for treating arthritis pain. The typical side effects of NSAIDs are less of a concern with topicals, but still need to be considered, especially for people with a history of stomach and heart issues.
- Lidocaine and menthol: A key ingredient in other topical pain relievers is lidocaine. It provides a numbing effect that can “really help with that more acute, stabbing pain sort of feeling,” Garling says. Menthol, which has a cooling sensation, is another common active ingredient in pain-relieving creams and sprays.
- Capsaicin: If you're a fan of spicy foods, you may be familiar with capsaicin, since it's the compound that gives hot peppers their kick. But it also helps block pain signals in the body and can be a safe and effective way to relieve joint and muscle pain, as well as neuropathy, or pain from nerve damage in the hands and feet, often experienced by diabetics, Garling says.
Just be sure to wash your hands after you rub it on your skin — you don't want capsaicin getting in your eyes. And don't give up on it too soon, Garling says. “The biggest caveat to this one is that you do have to use it regularly. ... Sometimes it takes up to two weeks before you notice a huge difference.”
One downside to topical pain relievers: They often cost more than their oral counterparts, Thompson says. A 5.3-ounce tube of Voltaren, for example, is $28, whereas a bottle containing 50 ibuprofen pills is about $5.
Talk to your doctor and pharmacist
The key takeaway to OTC pain medication is to keep your health care provider in the loop, says Hillary Lum, a geriatrician and assistant professor in the Division of Geriatric Medicine at the University of Colorado School of Medicine — especially “given that there are now more and more prescription-strength medications that are over the counter and the package inserts are really difficult to understand.”
Her advice? Bring a list of everything you are taking, “including your supplements and your over-the-counter medication” to your provider at least once a year. Don't forget to add any CBD (cannabidiol) use to this list, Lum says. Oils, lotions and gummies containing CBD have become prevalent, especially as an alternative pain reliever, and just like any other OTC substance, your doctor should know if you're using it.
And remember: If you're stumped in the medicine aisle, check in with the pharmacist for guidance. “We're the only ones that you can walk up to in your CVS and your local drugstore and talk to within seconds,” Garling says. “And if we're back there behind the computer, don't be afraid to ask for us — because we actually love questions.”