Your Checkup: Health Conversations for Motivated Patients
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From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
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Your Checkup: Health Conversations for Motivated Patients
Tylenol vs. NSAIDs: Which Pain Reliever Is Right For You?
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We break down the key differences between Tylenol (acetaminophen) and NSAIDs (ibuprofen, naproxen, aspirin) to help you make informed decisions about which pain reliever is right for you. This evidence-based discussion draws from top medical sources to explain how these common medications work differently in your body.
• Tylenol works on perception of pain and fever in the brain but doesn't address inflammation
• NSAIDs reduce pain, fever AND inflammation by blocking the prostaglandin cascade
• Both medications are commonly used for everyday pain including headaches and general discomfort
• NSAIDs are usually more effective for inflammatory conditions like sprains, arthritis, and period cramps
• Tylenol's main risk is liver damage at high doses (max 4,000mg daily for most adults)
• NSAIDs can cause stomach ulcers, GI bleeding, increased blood pressure, and kidney problems
• Consider your medical history when choosing—liver issues (caution with Tylenol), stomach/heart/kidney problems (caution with NSAIDs)
• Age is a factor—older adults generally face higher risks with NSAIDs
• Taking NSAIDs with food can help reduce stomach problems
• Always read labels and follow dosing instructions carefully
Share this episode with friends or family who take these medications regularly to help them understand what they're putting in their bodies.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Dolesky, a family medicine doctor in the Philadelphia area, and I'm Nicola Ruffo. I'm a nurse and we are so excited you were able to join us here again today. This isn't my line. This is from Mike. He's getting an early shout out in this episode. I don't know whether this came out of his own mind or he saw this somewhere, but it was certainly a bad week to be an alliterative celebrity.
Speaker 2:I feel like that came from his mind.
Speaker 1:I hope it did and like I hope he gets a kick that like right from the jump. He's getting credit for this. Uh, you know, hulk Hogan passed away and Ozzy Osbourne passed away. That's what we have to say. Um, both are no longer with us and that's what happened.
Speaker 2:Also, was it one of the guys on the Cosby Show? Oh yeah, I don't think he was an alliterative celebrity, though.
Speaker 1:He wasn't, so unfortunately for him. And honoring or remembering his name it doesn't quite fit what we're trying to do here, as we really, at the end of the day, respect Mike's sense of humor.
Speaker 2:Yeah, it's a good one, it's a great one.
Speaker 1:So, yeah, that's that to open up the show here. My second thing I have to talk about is the social contract you engage in when you sit in a spot at the beach.
Speaker 2:Yeah, yeah.
Speaker 1:Let me set the scene for you. You go to the beach. It's a wide open area. It's during the week.
Speaker 1:You pick one spot and there's no one around you beach is miles long miles long, no one around miles long, miles wide, and there's no one around you whatsoever. And so then a small family, seemingly on their like cousin with children, family reunion, decide to go 10 feet from you. Now, they were nice, but I can't help but think that now, if my piece is being disturbed, I've entered into this tacit social contract where if I get up and move, they know why.
Speaker 2:Yeah, who cares. Do you remember Was it last summer? I swear? It was like every weekend we were on a run. It was like every weekend, every time we went to the beach and sat down, there was like people or like a large family who sat like extremely close to us, like we could lean over if we've really like like extremely close to us, like we could lean over if we've really like leaned over and stretched, like we could, you know, grab a snack from them maybe we smell good we have moved before.
Speaker 2:I don't care. Get out of here so, like I, I didn't come to the beach with a kid. I don't want to sit next to one of them while they're crying and be that close. Get out of here, go somewhere else.
Speaker 1:I was here first, but now, since you're here, I'll leave it is a very like you could sprinkle some of this on me, because my perspective is I don't want to offend these strangers by moving no, they committed the first offense by being too close to you.
Speaker 1:I mean truly. The most recent instance of this is like Since that happened, because we realized that we went to a congested part of the beach. The beach is miles long, but it was thin, narrow beach. So it makes sense to me that there's only so much real estate in this area to do that. But this one Very different. We moved to a different beach. It's much wider. There is a lot more room. They could have picked anywhere. But then I got the good bit out of it. The guy came over and he complimented my sandwich.
Speaker 2:It was a good sandwich.
Speaker 1:He just walked right up to me. He was like my 11-year-old fat kid in me is screaming right now when is that sandwich from?
Speaker 2:So jealous I can't believe he didn't bring a sandwich home for me.
Speaker 1:You know, I did think about it. There was a part of me when I was driving back thinking I guess I should have brought her a sandwich home if I was here. But then the other part of me was.
Speaker 2:Well, you were making dinner and stuff.
Speaker 1:It is my personal duty that I have bestowed upon myself to pick you up while you are injured with your toe. Um, give an update to the audience. How's it, how's the toe going?
Speaker 2:Oh, the toes going great. I put a shoe on for the first time this week. Every day I wore a sneaker to work, so that was nice.
Speaker 1:That's great.
Speaker 2:Yeah.
Speaker 1:Road to recovery.
Speaker 2:Road to recovery. I got some toe cages for the Peloton.
Speaker 1:What's a, what's a toe cage that you put on?
Speaker 2:for me what's a toe cage? Yeah, um, it's a. Is that what they're called A toe cage, a shoe cage, a foot cage? Nicholas oh my God, like the thing, you can wear a regular sneaker and it just, you know, envelops your foot, instead of putting on the narrow peloton shoe and clipping in, because I still can't put that kind of shoe on yet yeah, that might be a bit for that, but road to recovery road to recovery the pinky toe is healing excellent.
Speaker 1:And then, um, this all happened on the same day. I, we were walking back, but we got back from the beach, or I got back from the beach and wanted to go try like a balcony bar, and you know, we get dressed up. We kind of like flip ourselves around real quick and then we're crossing the street and I see this guy. He's like an older gentleman, older than me and a little disheveled looking maybe. I walk up to him and his backpack is like totally open, and I just like stand next to him, we make eye contact and I'm like, sir, your backpack is open. I'm not sure if that's how you like it. He looks at me. You have a one count, two count, three count. It's empty.
Speaker 2:Yeah, that's why you don't talk to anyone around here. We're not at the beach. It is so funny how, like, when we go to the beach or like are in the suburbs and we're like walking all year or whatever, and a random person walks by the like high that you get when you say hi to a stranger and they say hi back is so funny oh, me personally yeah, oh oh my god, yeah or like doing the wave when someone drives by oh the, the wave with the drive-by is just.
Speaker 1:I have no idea who they are. They could be the worst person on the planet, but they gave me that wave. Oh man, I love it. It just gets me going, and this reminds me that we were doing this thing at the beach. But we're driving, it's fun, this is innocent fun, and we're driving the car. I'm usually in the driver's seat, you're in the passenger, princess, and we just start waving at oncoming cars and I would say, like one out of every five, we get a good wave uh-huh, we do that is exhilarating because then you know they're actually paying attention to you on the road.
Speaker 1:Some people are just like totally out there and they have no idea what's going on. But yeah, that wave is awesome, I love that wave. Oh, my god, um, any meals of note this week?
Speaker 2:um well, you made a delicious sirloin the other night like top tier that one was that time. Butter, butter, that you did. And then we went and got tom's dim sum on friday after we finally picked out our wedding bands. That was a fun day look, you need.
Speaker 1:That was fun. I, that was really fun, they. So our normal person who we like normally work with wasn't there. We thought she would be, but it was her birthday and she left. And then we got the guy who helped our friend Dan pick out his engagement ring for his fiance. And we were a little tepid at first, you know, because I was like, oh, we like have this relationship with this woman. She helped me get the engagement ring. This guy made the sale and put it under her name and he was so honest and he made it really fun.
Speaker 2:Yeah, that was really fun.
Speaker 1:We were in there for like almost two hours, maybe like an hour and a half yeah, well, it's a big decision and, uh, you know you want to make it right, but I think he brought out the one you liked and oh my god, I'm so obsessed.
Speaker 2:I can't wait to get it.
Speaker 1:I can't wait until it comes in yeah, I mean, you've been looking at this video for like 30 times, like 20 times a day I love it. You love it so much. I is, you know, because they were like hemming and hawing over, like this style, that style, and they're all kind of similar and I felt okay about them and like obviously they're all beautiful, but he brought out that one and that was it. You just knew. Yeah, big winner.
Speaker 1:Big winner and then tom's dim sum, which they had some updates. We've talked about this restaurant before. They are a dim sum restaurant. They are all business, no fluff. But there's a little ambiguity in our experience. This time in the bottom right corner of our table was a qr code oh yeah which I thought was so on brand for them, given that they're, like, all about efficiency like the least amount of interaction you can have, the better yeah I love that but they like, but they still came over.
Speaker 1:Yeah, that was great. I love their crab rangoon, we love their cold noodle, the cold noodle is delicious I miss that place.
Speaker 2:we hadn't been there, and well, because like I couldn't walk there, so it was also like celebratory, because I could finally walk to Tom's dim sum.
Speaker 1:Yeah.
Speaker 2:Which is like not the closest. I mean easily, easily walkable.
Speaker 1:Sure, but I think it's over a mile, yeah, and we weren't, you know, just trying to be careful with the toe there, yeah, speaking of toes, when you were Speaking of toes, well, I don't know if we're gonna um, if, we dump right into it as a transition point.
Speaker 2:But um, oh, oh, I see I see the segue.
Speaker 1:You see the segue going for, or do you want to talk about amy bradley?
Speaker 2:oh we, how long has it been it's been about 10 minutes yeah, that's it. Yeah, yeah, we can talk about amy bradley. Where do we start? I? I mean, the biggest criminal offense in that documentary was that her parents named her brother Brad Bradley. Do you think his full first government name was Bradley Bradley, or maybe he's like a Bradford?
Speaker 1:Could be a Bradford Bradalosius. That was bad.
Speaker 2:Brad Bradley.
Speaker 1:Bradlocious, that was bad, brad Bradley, bradley.
Speaker 2:Bradley. Anyway, this girl goes missing on a cruise ship and then it's like what time, huh, what time Like set the scene. What time it was like early in the morning.
Speaker 1:No, like it didn't happen yesterday. Oh, it was like I don't know, it's like early in the morning.
Speaker 2:no, like it didn't happen yesterday oh, it was like I don't know early 2000s, right late 90s, oh, late 90s, yeah, um, yeah, she was missing on a cruise ship. And then it's like did she jump, did she fall, did someone take her? And then, yeah, it was like it was like spooky kind of and like weird and like I was like I love like a murder documentary.
Speaker 2:I love a scary movie. I don't get like spooked and like freaked out, but we like watched the whole thing. I think it was like three episodes. We watched the whole thing, stayed up kind of late watching it and then after I was like we need to like put something funny on, cause I'm going to have weird dreams now we put on modern family for a couple of minutes.
Speaker 1:Yeah, very eerie. I it was eerie because this entire, like her parents are still looking actively and this like documentary comes out and like drums up a whole bunch of interest and it's very compelling like they bring in a lot of supposed eyewitnesses who claim to have seen her and you know there are some nefarious accusations about things that may have happened. So I you know, if you're into that sort of thing, it's on Netflix.
Speaker 2:Yeah.
Speaker 1:Another reason to not go on a cruise. Yeah, In the last month and a half we've been very down Arrow pointing down on the cruises.
Speaker 2:Yeah, my arrow, I think, has always been down, but that's just a personal preference To each their own.
Speaker 1:But yeah, arrow continues to point down. There's no law, it's a lawless land in the middle of the ocean, in the international waters yeah.
Speaker 2:And which impaired their ability to really go looking for her a lot. And then, I guess, at one point they had maybe some sort of like evidence or like what do they call it Reasonable cause, or whatever that's not it Shadow of a doubt, or is that just a colloquial thing? No, that's a colloquial. They, I guess, like otherwise like would have had a reason to go get the guitar player or like take him in, like whatever. But they like couldn't because he was like in another country, and blah, blah blah yeah, spooky stuff yeah don't love it and as you.
Speaker 1:As we kind of talked about here, modern family has become a really nice comfort show.
Speaker 2:These guys are so funny yeah, I don't know if we talked about this. We may have. You are phil dunphy, like unironically, like I swear every episode there's like something that happens and I'm like I've. I'm either like watching my life or I'm watching my future and like I love it.
Speaker 1:It's great. What a terrific show we're only on season one, you know, that'll be, I think, good downloadable content for our 30 hours of travel to our honeymoon oh, totally, I mean we're gonna need, we're gonna need a lot and we need like chargers I also like I feel like we need to save up some stuff.
Speaker 2:I feel like we need to save up some stuff, like we're really excited about the biggest loser documentary That'll kill an hour or so on the plane, you know.
Speaker 1:I think there are a whole series that we can watch, like we haven't seen Yellowstone.
Speaker 2:Yellowstone didn't grab me, I guess I could give it a second chance.
Speaker 1:In part. I feel like it's like the first hundred pages of a book, like if you push through, might really all right.
Speaker 2:Intern, just hopped up on the couch just because I love when he's on the couch. He's so cute so cute.
Speaker 1:I can't tell if the wet spots are like his pee or his drool from licking that's so cute.
Speaker 2:He like licks the couch no, I think it's from licking his paws that was a little itchy paws. Yeah, let me take him back to the vet to see. I don't know if that zyrtec is helping him a ton anymore anyway well, it's not zyrtec or itching dog paws that we're talking about a classic rivalry. Maybe, perhaps. The pharma rivalry the good old Tylenol or Advil, or Tylenol and NSAIDs. Which is better?
Speaker 1:Which is better, which is for you At the end of the day. You know that, of course, we'll always say that becomes a question between you and your doctor, but everything we talk about today is from top tier sources like the American Academy of Orthopedic Surgeons, american College of Sports Medicine, cochran Reviews, new England Journal of Medicine and the American Journal of Managed Care is where we got all this information to help with this breakdown today. All this information to help with this breakdown today. All right, so these are both really two really common medicines that are used like all the time by people. They're also both over the counter, which also sets the stage for a decision to be made for people, and my hope with this episode is that we kind of make it a little more clear for people how to make that decision. Yeah, yeah, can you take us at the beginning here? So what exactly are these medicines in their most basic form?
Speaker 2:Well, tylenol is also called acetaminophen and that works on like fevers and pain, but not pain that comes from inflammation. And then NSAIDs are um, what would be ibuprofen, naproxen and aspirin and they help with pain, fever and like swelling and inflammation.
Speaker 1:Yeah, the like, the breakdown of these is actually really interesting. Um, in med school is one of the first lectures that we got where the acetaminophen works in the brain and it's like someone's perception of pain is what it's working on and really great for that as well as the fever. So that was, I mean, really interesting things. And then the NSAIDs actually get at the specific. There is like a breakdown, there is like the inflammation cascade that happens and it impairs an enzyme in that cascade that stops the inflammation from happening and so it really like mechanistically it really is interesting. I realize that might not be interesting to everyone listening.
Speaker 1:They really kind of want to get the nitty-gritty common uses that people have. So both are used for everyday pain. People use them for headaches, fevers, dental pain, an ache, a bump. Nsaids usually are better for, like you mentioned, this inflammatory pain. So if something happens with a sprain, there might be some inflammation that happens after that.
Speaker 1:There are many different types of arthritis. There are going to be osteoarthritis, rheumatoid arthritis, so sometimes arthritis can be helped with NSAIDs and then, interestingly, helped with NSAIDs and then, interestingly, period cramps can also be helped more by NSAIDs. And that's because that molecule, the prostaglandin, that's the molecule that is made in the inflammatory process that NSAIDs help reduce. Prostaglandins are one of the main players in causing the discomfort with the period cramp and so in that specific case, if it's healthy for you and you've talked to your doctor and it makes sense, nsaids might be good for that situation.
Speaker 1:Then there are certain things like we're going to talk about, where people have certain side effects, where Tylenol. You might need some help with discomfort, but Tylenol might just be a better option for you. So if you're someone who has stomach issues, heart disease, or if you're a little older, tylenol might just be your friend, more so than an NSAID like ibuprofen, otherwise called Advil, naproxen, otherwise called Naproxen, or Aleve. So now that we've talked a little bit about how they work and sort of like what they kind of narrow down into what are the side effects of each and the safety. So what are some risks associated with Tylenol?
Speaker 2:So Tylenol is pretty safe if it's taken in the recommended doses. But in really high doses or in an overdose it can cause liver damage and then, in rare cases, it can cause liver damage and then in rare cases, it can cause a severe skin reaction.
Speaker 1:Yeah, I would say you know a lot of people end up thinking like if they have liver disease, it's an important conversation to have with your doctor about how much, if any, tylenol is safe for you. The top end recommended dose for someone who doesn't have any liver problems and it's listed on the box. You can find this anywhere available online is 4,000 milligrams a day, and so one Tylenol tablet could be I mean a regular one could be 325 milligrams. Another could be branded as 500 milligrams. I've also seen 625. I've seen prescriptions written for 1,000 milligrams of Tylenol every eight hours or so, and so the level of that is really between you and your doctor or what you see available over the counter, since you can go to the pharmacy and buy this. But the point is just don't use too much and just be safe, because there is an upper limit. You can hurt yourself. Acetaminophen toxicity is something that takes people to the hospital. People do sometimes get admitted to the intensive care unit for this. It is not an uncommon thing. So when you have important tools like this just available in the pharmacy and you're going to choose to do it yourself, just be careful. It's really the end of the day and I'll take this next one. The Tylenol risks we covered, but the NSAID risks are a little bit wider and there are a few more of them. So long-term consistent use can cause stomach ulcers. It can kind of just sit in the stomach lining and it can cause issues right there. So that is something to be aware of. It can increase the risk of GI bleeding and so I'm more so thinking about aspirin in this situation.
Speaker 1:Aspirin is considered an NSAID and it's a very important one. It's used widely for a lot of different characteristics, like it used to be used, like everyone used to take it once a day for prevention of heart attack and stroke, and now people have come back on that recommendation quite a bit. Or if people have had a heart attack or a stroke, they use it to prevent another one, and that's something called secondary prevention. But it's a powerful medicine, even though it's kind of available everywhere and you can get your hands on it, and it can cause people to bleed more, and I mean not uncommonly. You see people who have fallen and they hit their head and they're on aspirin and that leads to some bad things, or they're having some GI bleeding, so like maybe they're pooping blood and they're on aspirin and that leads to some bad things, or they're having some GI bleeding, so maybe they're pooping blood and they're on aspirin. It's something to think about so it's important.
Speaker 1:It is a side effect that does happen, albeit not to everyone, but it's something to think about. I've had a longtime now good friend, old patient of mine who we were just working on his hypertension diagnosis, who you know we were just working on his hypertension diagnosis and you know we were going through the litany of things and figuring out like it took a couple visits but like why he had such high blood pressure and turns out he had hurt some part of his hand maybe it was his thumb or his wrist and he was taking a lot of Advil every day, or maybe naproxen he was taking all day to try to get through the discomfort and it turns out that was why his blood pressure was elevated. And so this is a side effect that can happen. If you use it too much, too often, it can worsen kidney function and, like we said before, slightly worsen bleeding risk, especially if it's combined with other blood thinners, things like the names of Eliquis Xeralto.
Speaker 1:Really, just be careful. If you're going to start combining these medicines. Ask your doctor if it's okay or if you have an ache or a pain. If it's safe for you, maybe you just think about taking Tylenol. So there are some key differences between these. We're trying to keep this episode as much of a like pitting one against the other. So, nikki, why don't you take us through some of the key differences between these two medicines?
Speaker 2:at the end of the day, Okay, well, not a difference, but they both reduce pain and fever. A difference for Tylenol is that that's better for any kind of well, not any kind of but you know stomach issues and then heart and kidney issues. Tylenol would be better over an NSAID and then an NSAID would be better for if you are having any kind of swelling or inflammation. The liver risk is very rare in NSAIDs and can happen with Tylenol at high doses.
Speaker 1:Yeah, I think that's just something to be careful of. And so at the end of the day, when you're going back and forth thinking which one should you choose, I would invite you to think about your medical history. Do you have any liver problems that are underlying? Have you been told you have kidney problems? Do you know you have heart problems or GI problems? That information will help inform one way or the other, which medicine might be better for you.
Speaker 1:Think about the type of pain you have. Is it about swelling or is it not? Think about how old you are, the amount of age I'm thinking that Tylenol is often safer than any of the NSAIDs in that class of people as a broad, sweeping generalization. And think about other medications that you could be on. Think about blood thinners or other things that interact with the kidney, like potentially a diuretic. Sometimes with NSAIDs you can take them with food as a useful tip to kind of avoid the stomach problems. Always read the labels to follow the dosing instructions that are given. So, after today's episode, if you ever stopped in a pharmacy aisle wondering which bottle to grab, we hope that this episode helped you, and if you've got friends or family who take these every day you can send them this episode so they can learn a little bit more about what they're putting into their body.
Speaker 2:Are you a Tylenol or Advil guy?
Speaker 1:Well, so now they're making I'm a both, I'm a both guy and um. I don't know if I would like you know a formally tell someone else to do this. Um, I haven't had any of the side effects happen from advil or naproxen, and so I feel that can help. Given that their side effect profiles are so different sometimes, I will alternate or take one over the other. This is a pretty noncommittal answer.
Speaker 2:What about you? Well, I think I've both now, but for a long time I was like strictly an Advil girly.
Speaker 1:Really I don't know why Headaches is one that they really are commonly used for.
Speaker 2:Yeah, I think that's why, because I just, you know, take it for my daily headaches.
Speaker 1:Thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor. Share this episode with someone if you feel like you learned something today and, most importantly, stay healthy. My friends, until next time. I'm Ed Dolesky. I'm Nicole Rufo. Thank you, goodbye, bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for complete information tailored to you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.
