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Chronic pain: Medication decisions

Acetaminophen

Acetaminophen is usually recommended as a first line treatment for mild to moderate pain, such as from a skin injury, headache or musculoskeletal condition. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It may also be combined with opioids to reduce the amount of opioid needed.

  • Generic (brand) names. Acetaminophen (Tylenol, others)
  • How it works. Doctors don't know exactly how acetaminophen works. Some scientists believe there may be a third type of cyclooxygenase, COX-3, that acetaminophen blocks. Acetaminophen doesn't affect the other two cyclooxygenase enzymes, and it doesn't target inflammation — only pain. It may be less effective than NSAIDs.
  • Benefits and risks. Acetaminophen is generally considered safer than other nonopioid pain relievers because it doesn't cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose — or taking acetaminophen with alcohol — increases your risk of kidney damage and liver failure over time.
  • Bottom line. Acetaminophen is generally a safe option to try first for many types of pain, including chronic pain. Ask your doctor for guidance about other medications to avoid while taking acetaminophen. Acetaminophen is not as effective as NSAIDs for the treatment of knee and hip pain related to osteoarthritis.