FURTHER, OTC pain relievers are distinguished from prescription-only narcotics such as morphine, codeine, fentanyl, methadone, oxycodone, propoxyphene and Vicodin.

ASPIRIN (ASA) is a salicylate, as are oil of wintergreen and all other derivatives of salicylic acid. ASA is the only salicylate among the NSAIDs listed in paragraph one (above). ASA in its standard dose of 325 mg is a very widely used effective pain killer, fever reducer and anti-inflammatory drug. Side effects can include irritation of th stomach, bleeding in the GI tract and elsewhere, and Reye syndrome, a very dangerous condition that can develop when aspirin is given to children suffering from chicken pox or flu. Aspirin and some other NSAIDs act by inhibiting COX-1 and COX-2 enzymes. Aspirin and other salicylates remain the cornerstone in the treat ment of what TV ads call "arthritis and rheumatism". There is far more information about aspirin and NSAIDs in my book, "Drugs and the Human body".

ACETAMINOPHEN (sold generically and as Anacin-3, Datril, Tempra and Tylenol) is not a salicylate. It is an aniline derivative. It is an effective pain reliever and fever reducer, but not effective clinically as an anti-inflammatory agent. Acetaminophen does not cause the GI tract blood loss and tendency to bleed seen with aspirin. It can be used in the presence of aspirin allergy. CAUTION: In large doses acetaminophen is toxic to the liver. Reports suggest that sometimes even normal doses can cause liver damage if used over a long period. READ THE PRODUCT LABEL. Young children are especially vulnerable to acetaminophen overdosage. There is preliminary evidence that long-term daily users of acetaminophen face increased risk of kidney damage. Exercise special caution when ingesting the extra-strength forms of this pain reliever. Acetaminophen can be purchased as the generic form, typically at less cost than the highly advertised brand names. It is the same drug.

IBUPROFEN is the generic name of the popular NSAID sold as Advil, Medipren, Motrin, Nuprin, Midol-200 and Trendar. Indicated for the temporary relief of minor aches and pains associated with the common cold, heachache, toothache, backache, minor pain of arthritis, and menstrual cramps, ibuprofen also has anti-fever and anti-inflammatory actions. Its low dose - 200 mg - makes it competitive with other NSAIDs. Unfortunately, cross reactivity betwen allergy to aspirin and ibuprofen has been noted. If you are allergic to aspirin, do not take this drug. As regards side effects, ibuprofen can irritate the stomach and cause some bleeding. There is some evidence it can damage the kidney, especially in the elderly. It can prolong bleeding time, but the effect is not as long-acting as that of aspirin. A massive study conducted at Johns Hopkins suggests that the risk of developing Alzheimer disease can be reduced by as much as 60 percent by frequent use of ibuprofen over 2 years or longer.

OTHER NSAIDs include naproxen sodium (sold as Aleve), ketoprofen (sold as Orudis KT and Actron), and fenoprofen (Nalfon). They all can have side effects that you should know about. Be sure to read the warnings on the labels.