Opioids are among the strongest pain management medications out there, and they’re especially effective for acute pain. However, chronic pain patients who take it for a long time can get addicted, which is why people often look for alternatives.

What Is the Strongest Non-Opioid Painkiller?

The strongest non-opioid painkiller, based on the opinions of most patients, is arguably ibuprofen. This painkiller is a non-steroidal anti-inflammatory drug NSAID.

NSAIDs are often used to treat cases of moderate acute pain like that after a dental procedure or managing chronic pain resulting from long-term illness.

Besides its analgesic ability, ibuprofen is also used to reduce the body’s inflammatory responses and lower fever, if present.

It’s widely available as an over-the-counter (OTC) drug and as a prescription medication. Ibuprofen is available as tablets, capsules, and topical creams.

Method of Action

Ibuprofen works by inhibiting both forms of cyclooxygenase (COX) enzyme; COX-1 and COX-2. COX is responsible for prostaglandin production.

Prostaglandins are chemicals that play a major role in the body’s inflammatory response to diseases. It also contributes to raising the body’s temperature, causing fever.

By inhibiting COX, ibuprofen indirectly reduces the production of those prostaglandins and, in turn, reduces their inflammatory response and fever-causing action, resulting in pain reduction.

Pharmacology

Upon ingestion, ibuprofen gets quickly absorbed in the gastrointestinal tract, leading to peak concentration in the blood within 1-2 hours after ingestion. That’s when the maximum pain relief effect is active.

However, the concentration of ibuprofen in the plasma quickly declines within a few hours, which is why a patient would often need multiple (usually three) doses of ibuprofen every day until the pain-causing factor is resolved.

After release from the plasma, ibuprofen gets metabolized in the liver to be later eliminated through urine.

Side Effects

It’s difficult to find a medication that doesn’t have side effects, and ibuprofen is no exception. Here are the side effects you should expect from ibuprofen:

1. Gastrointestinal Issues

COX-1 enzyme contributes to the protection of the stomach lining. When it gets inhibited by ibuprofen, the stomach lining might get irritated.

This is especially common if the patient eats a lot of spicy food, or if they rely on the drug for extended periods to relieve pain.

If the stomach irritation is ignored, it may result in stomach ulcers, acid reflux (heartburn), nausea, and vomiting.

2. Cardiovascular Effects

Using high doses of ibuprofen over the long term may increase the risk of heart attacks and strokes. That is more likely if the patient is already suffering from a heart condition or high blood pressure.

The patient needs to inform the doctor of any heart issues before the doctor writes down their pain medications.

3. Kidney Issues

Long-term usage of ibuprofen can irritate the kidneys, especially for a patient who is already suffering from kidney problems.

Even if the patient doesn’t have kidney conditions, it’s important to notify the doctor if there’s pain on the sides upon taking Ibuprofen. Ignoring the case could lead to a condition known as chronic interstitial nephritis.

4. Liver Damage

Drugs are either primarily broken down in the kidneys or the liver. Since ibuprofen is mainly metabolized in the liver, then it’ll have more effect on it.

In rare cases, ibuprofen might cause liver damage, especially with high doses or prolonged use. Also, patients with liver failure shouldn’t take ibuprofen.

5. Other Side Effects

Even healthy ibuprofen users who are just taking it for some headache or dull pain might experience some other side effects. These involve:

  • Dizziness
  • Ear running
  • Diarrhea
  • Constipation
  • Drowsiness

Drug Interactions

Drug interactions are when the patient takes two or more drugs that react with each other and cause an unknown response. While some drugs can be safely combined or even intentionally combined to amplify the effect, most unknown interactions are harmful and should be avoided.

Here’s a list of the medications that you shouldn’t take together with ibuprofen to avoid interactions:

1. Anticoagulants

Blood thinners like heparin and warfarin are prescribed to patients with a history of emboli. These emboli result from a defective function of the blood platelets, so blood thinners are given to reduce the chances of emboli formation.

Such patients are often at risk of bleeding extensively from small wounds, and taking ibuprofen can increase the bleeding risk. As such, they’ll need other medications for managing pain.

2. Aspirin

Aspirin is given to patients who are at risk of heart attacks by preventing the platelets from aggregating inside the heart tissue and forming emboli.

Such an effect will be diminished if Ibuprofen is ingested, which is why patients who are taking aspirin shouldn’t take Ibuprofen.

3. Corticosteroids

Corticosteroids are used for many medical problems, but they have a list of side effects. One of those is gastrointestinal irritation.

Adding that to the gastrointestinal irritation of Ibuprofen, the risk of internal gastrointestinal bleeding is increased.

4. Some Blood Pressure Medications

Certain blood pressure medications like ACE inhibitors and diuretics interact negatively with ibuprofen.

It lowers their effectiveness in reducing high blood pressure, rendering the patient liable for hypertension.

5. Lithium

People with mania or euphoric moods take lithium to calm them down. Should these people take ibuprofen for any reason, they might get lithium toxicity.

Because of the reduced prostaglandin effect of Ibuprofen, the kidney will filter and extract less lithium from the blood. When it returns to the bloodstream along with the lithium the patient is already taking, lithium toxicity can occur.

6. Methotrexate

Methotrexate belongs to a class of medications, antimetabolites, which help treat cancer by slowing cancer cell growth and reducing chronic musculoskeletal pain. This medication is eliminated through the kidney.

This elimination may be reduced by ibuprofen’s effect, which leads to the retention of methotrexate in the body, leading to toxicity.

What Is the Dose of Ibuprofen?

Ibuprofen’s dose will vary according to the age, condition, and accompanying medications. So, it’s important to treat the following information as a guideline and not as a replacement for a doctor’s prescription.

That being said, here are the doses:

  • For adults: The recommended dose for adults is 200-400 mg every 4-6 hours per day. The maximum recommended dose is 1,200 mg per day.
  • For children: The dose is based on the child’s weight. The usual dose is 5-10 mg per kg.

Because of ibuprofen’s effect on the stomach, it’s best to take it with milk or food to reduce its irritation on the stomach’s lining.

How to Amplify the Effect of Ibuprofen?

Unlike opioids, which are often prescribed for severe pain, ibuprofen is for treating mild to moderate pain. In other words, despite satisfying most patients, it’s not as strong as an opioid in pain management.

So, how do you get an ibuprofen effect that’s similar to or even better than an opioid? It’s by mixing it with acetaminophen, commonly known as Tylenol.

These two medications are often safe to take together to amplify the pain relief for the majority of patients. Many doctors and dentists prescribe them together as well.

If you’re going to take them together, the maximum dose of ibuprofen should not exceed 1,200, and your maximum dose of Tylenol shouldn’t exceed 3,000 mg.

Other Strong Non-Opioid Painkillers

If the patient doesn’t like or isn’t able to take ibuprofen for any reason, there are other alternatives they can try. These include:

1. Corticosteroids

Steroids are a class of medications that have immunosuppressive and anti-inflammatory properties. They’re not strictly made for pain relief, but they work wonders when the majority of the pain is caused by an inflammatory response from the body.

Some examples of corticosteroids are mometasone furoate (inhaler), dexamethasone (eye drops), fluticasone propionate (nasal spray), methylprednisolone (pills), and hydrocortisone (injection).

Corticosteroids are among the better choices for pain relief if the patient is suffering from:

  • Arthritis and tendonitis: Steroids can be injected directly into the inflamed joints, which helps in reducing inflammation and pain relief. This is especially effective in patients who suffer from arthritis.
  • Autoimmune diseases: When a patient has an autoimmune disease, their white blood cells attack the cells of their own body. Corticosteroids are often used to manage the pain and inflammation associated with such conditions.

2. Anticonvulsants

Anticonvulsants, or antiepileptic drugs AEDs, are designed primarily to treat epilepsy and seizure disorders.

Such seizures occur because of sudden electric charges in the brain that lead to uncontrolled contractions. AEDs work by reducing the nervous membrane excitability and reducing the amount of electric charges passing through these nerves.

However, it was found that this nervous calming effect is also useful for treating chronic pain, especially in cases of nerve pain.

Among the anticonvulsants used to treat pain are Gabapentin, Pregabalin, and Carbamazepine. In general, anticonvulsants were proven successful in treating pain in cases of:

  • Diabetic neuropathy
  • Postherpetic neuralgia
  • Fibromyalgia
  • Trigeminal neuralgia

3. Antidepressants

Much like anticonvulsants, antidepressants weren’t initially designed for pain management. Instead, they’re made to help those who are suffering from mental illnesses like depression and anxiety.

However, they are among the common medications used to handle cases of chronic pain.

Antidepressants work by affecting certain neurotransmitters in the brain, like serotonin and dopamine, which can boost the patient’s mood and resistance to pain.

Antidepressants don’t directly increase those neurotransmitters. However, one of the ways they work is by reducing the reuptake of these neurotransmitters, which keeps their effect longer in the body.

Antidepressants are especially effective for patients suffering from:

  • Chronic lower back pain: Any pain that lasts over 12 weeks is called chronic pain, and it can be especially annoying if it attacks the lower back. Antidepressants can help with chronic pain that doesn’t seem to go away with standard medications.
  • Neuropathic pain: Neuropathic pain can be among the worst to bear, as it comes from the nerve endings or central nervous system. If that neuropathic pain is caused by diabetes or shingles, antidepressants can be quite effective.
  • Cancer pain: Cancer is often accompanied by both physical and mental pain, which is one of the situations where antidepressants can be extremely effective.

Frequently Asked Questions

Can Anyone Take Ibuprofen?

Despite being an OTC drug that’s mostly safe for everyone, taking ibuprofen without a doctor’s consultation can be a bad idea. This is especially important if you’re already taking other medications.

The patients who shouldn’t take ibuprofen include but aren’t limited to:

  • People with allergies to NSAIDs
  • People with stomach issues, peptic ulcers, or bleeding disorders
  • People with kidney or heart diseases
  • People who take medications that can interact with Ibuprofen, like methotrexate and warfarin

Are NSAIDs as Strong as Opioids?

Because they’re designed specifically to treat pain, opioids are often stronger than NSAIDs. Opioids work by binding to the opioid receptors in the brain, blocking pain from being transmitted to the brain through these receptors.

However, NSAIDs might have even better results than opioids when the cause of the pain is inflammation because they primarily work on reducing it.

Can I Take More Than 1,200 MG of Ibuprofen per Day?

Your doctor may prescribe you up to 3,200 mg per day in severe cases. However, if you buy ibuprofen as an OTC drug, you shouldn’t exceed the recommended maximum dose of 1,200 mg.

Otherwise, the side effects of COX inhibition will manifest more profoundly.

Conclusion

It’s difficult to assume that ibuprofen is the absolute strongest non-opioid painkiller. However, it seems to work favorably with most people, which is why it’s a good choice for those who don’t want to risk the addiction susceptibility of opioids.

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