By Deborah Austin, via Wikimedia Commons

About 2000 years ago, humans began using extract from willow bark as a treatment for pain and fever. Although they did not know it, they started humanity’s long relationship with NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs. NSAIDs are still one of the most common treatments for pain and fever, along with several other prevalent options. A common pain medication that most everyone has either used or heard of is Tylenol, however contrary to some popular misconceptions, Tylenol is not an NSAID, but rather belongs to another popular category of painkillers- Acetaminophen-based medications. There are many differences in both the functions and side effects of NSAIDs and Tylenol that must be considered when choosing which is best for the situation.

Primary Function

Both Tylenol and NSAID pain relievers have been used for some time to control pain and fever. NSAIDs, however also reduce inflammation, while Tylenol and other Acetaminophen-based medications do not. This means that for any type of pain where inflammation is the source of the irritation, NSAIDs will better relieve the pain.

In addition to the effects seen in patients, there are also key differences between Tylenol and NSAID pain relievers in how they function. NSAIDs work by suppressing the cyclooxygenase-2 gene, or COX-2, hence the name of the recently developed family of NSAIDs, COX-2 inhibitors. Other NSAIDs that are not part of the COX-2 family often work by suppressing COX-2 to a lesser extent, while also suppressing COX-1 and possibly other less prominent strains of COX as well. The fact that Tylenol suppresses fever in a similar way to COX-2 inhibitors, but lacks many of the other properties of NSAIDs has led scientists to believe that there is a strain of COX that has not yet been discovered which is able to be suppressed by Acetaminophen. This would explain the similarities in the fever-suppressing and painkilling properties that Acetaminophen and NSAIDs share, while it lacks the anti-inflammatory properties and other NSAID side effects. This possibility has caused scientists to think that Tylenol and similar Acetaminophen-based drugs may work in a much more similar way to NSAID pain relievers than was initially thought. Due to its lack of anti-inflammatory properties, however, Tylenol still cannot be classified as an NSAID in its current definition.

Risks

NSAID pain relievers and Tylenol each have their own host of drawbacks. NSAIDs tend to be very rough on the stomach, often causing nausea and/or vomiting, along with general stomach pain and irritation. Recent developments have led to the development of the aforementioned COX-2 inhibitors family of NSAIDs, which are not as irritating to the stomach, but have instead been found to cause heart problems, unlike their less-gentle Aspirin-based counterparts. For those without a history of heart-disease, however, this family of NSAIDs tend to offer an impressive level of competence for alleviating pain, fever, and inflammation, with minimal stomach irritation. Additionally, kidney problems have been shown to develop following regular, long-term use of NSAIDs.

Tylenol is very gentle on the stomach, has shown no negative effects on heart health, and is generally considered by many medical professionals to be less risky in terms of side effects than NSAIDs. The biggest problem that faces users of Tylenol is that Acetaminophen can cause damage to the liver. This risk is greatly magnified with the consumption of alcohol while Acetaminophen is still in the blood stream. For those that do not exceed the recommended limit of Tylenol or other Acetaminophen-based medications and do not combine these medications with alcohol, problematic liver damage from the use of these drugs is rare, generally not seen except for in patients that use these medications on a regular basis for a very long period of time. The problem with this, however, is that Acetaminophen is a component in so many over-the-counter medications that it is very possible to consume an unsafe amount without realizing it, which is why it is always important to check the active ingredients in medications before combining them.

Conclusion

While Tylenol cannot be considered an NSAID due to its lack of anti-inflammatory properties, they do function in a much more similar way than was originally thought, and share some key functionalities. Only further research will make clear exactly how closely related these two categories of painkillers are. It is important to read up on your medications and choose appropriately.

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