Which Is Best For Pain: Tylenol, Advil, Or Aspirin? (And What About Krill Oil?)
Helpful (and very good) explainer piece at Vox by Julia Belluz, based on a research by Oxford's Andrew Moore:

Moore has done a number of systematic reviews on over-the-counter pain medications, looking at all the available evidence to figure out which ones work best for various problems. I asked him to describe the overall success rates for the most common three: acetaminophen (like Tylenol), ibuprofen (like Advil), and aspirin.

Like all good evidence-based medicine thinkers, he was able to provide a very practical answer: "If you're talking about aspirin in doses of 500 to 1,000 mg or two tablets, 30 percent of people get relief from acute pain. For acetaminophen at doses of 500 to 1,000 mg, about 40 percent have a success. For ibuprofen, in its normal formulation at something around 400 mg or two tablets, about 50 percent have success."

Now, Moore was referring here to acute pain that strikes after a specific event, like a surgery, a cut, or a burn, but his message was simple: Ibuprofen seems to work best, followed by acetaminophen, and then aspirin.

Also, per a BMJ meta-analysis (study of the studies out there):

Acetaminophen didn't seem to help most sufferers of chronic low back pain, and that it barely alleviates pain in people with osteoarthritis. As the researchers wrote, "We found that [acetaminophen] is ineffective on both pain and disability outcomes for low back pain in the immediate and short term and is not clinically superior to placebo on both pain and disability outcomes for osteoarthritis."

They also noted that patients on acetaminophen "are nearly four times more likely to have abnormal results on liver function tests compared with those taking oral placebo."

Personally -- and I have no idea why this is -- I have found that the NSAID (Non-Steroidal Anti-Inflammatory) Naproxen (500 mg) is the only thing I've tried that can push back an impending migraine and allow me to function. I only occasionally have migraines, and I'm careful not to take it too often. (It also works well for me on hangovers, which I get if I drink two glasses of wine and don't drink enough water -- yay, hearty drinker me.)

PS A Cochrane Collaboration review (here in abstract) did not find Naproxen very effective for others. Here's the full review.

Another option: Krill oil. Dr. Michael Eades finds it effective for pain relief.

A number of studies have shown that krill oil is tremendously effective in reducing LDL-cholesterol, raising HDL-cholesterol, and lowering blood sugar. It has been shown to be effective in treating the pain and inflammation from rheumatoid arthritis and aches and pains in general. One large study showed that krill oil has tremendous benefits in terms of symptom reduction in PMS and dysmenorrhea. And it has been shown to be effective in the treatment of adult ADHD. In all these studies krill oil was tested against fish oil and not simply a placebo.

...Are there any downsides to this miracle substance? Only one. It is a little more pricey than fish oil, but, as with all things, you get what you pay for. Virtually all krill oil is produced by Neptune Technologies and shipped to the various supplement manufacturers, so any krill oil you get will have come from the same place and be the same dosage. The only unknown is how long it has been sitting around in a warehouse somewhere, which is, of course, the same unkown with fish oil. At least with krill oil, thanks to the high anti-oxidant content, the shelf life is much longer.

However, Dr. Eades writes:

I neglected to mention in my previous post that popping a couple of fish oil and krill oil caps don't give the same immediate relief as popping a NSAID. It takes a while-a couple of weeks in my case-for the fish oil/krill oil to provide the same degree of pain relief as the NSAID. So, the take home message is: don't take your first dose and compare it to the relief you got with a dose of NSAID. If you do, you will not believe the program works and will probably think me an idiot. It takes a while, so give it time. In the study I mentioned in the last post, the subjects took the fish oil for two weeks along with their NSAIDs, then tapered off the drugs and treated their pain with the fish oil alone.

Here's the krill oil Gregg and I take -- 1,000 mg, once daily. I also take 5,000 mg of vitamin D -- in this brand recommended by Dr. Eades. Just $15.25 for 250 rice grain-sized capsules.

via @medskep