Pain Killers Comparison Chart Painkiller Summary

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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, both prescription and non-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

.top of page 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)	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	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

top of page 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 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

top of page 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.

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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