yes, it can be that bad. my son had this with EVERY tooth!!! Some are harder than others particularly canines and molars. Each kid is different, we did not know when my daughter was cutting teeth until she had the tooth....she only complained about her molars.
If you want to do medication -
Tylenol works, Ibuprofen works better, and a combo of the two does wonders. I know many people are against medications, but (I said this in another post) I am against having my children in pain unnecessarily. I don't think the tylenol will hurt him, though you do want do give gingerly. He may take it becasue he likes it (weird, i know). We would try as many non-medical things during the day and medicate at night..sleep helps improve mood and pain tolerance...=-)
Some non-medical ideas - those green mesh sacs at babiesrus or target - fill it with an ice cube or frozen fruit cube and give him that, wet wash cloth put in the freezer, teething cookeis (very messy but effective), let him put cold, hard stuff in his mouth - my son literally eats ice cubes - crunch crunch, but he is happy so I am too.
People swear by those teething things you can get at whole foods, personally, I have two kids..didnt help worth a darn. but, like i said, each kid is differnt...and with that being said, so is each parent and what you can tolerate in terms of fussiness from your child. Some days I had difficulty being sympathetic -he got more medication that day - sounds bad? well, I was much happier and he was happier - sounds like a good deal to me.
Good luck, I know this sounds arbitrary and, well, vague..that is because every day and every situation with a child is different, play it by ear and keep trying stuff until you find something that works.
Good Luck!