Advertisement

Self-Medication With Over-the-Counter Analgesics: A Survey of Patient Characteristics and Concerns About Pain Medication

Published:September 28, 2018DOI:https://doi.org/10.1016/j.jpain.2018.09.003

      Highlights

      • We studied individuals who self-medicate pain with over-the-counter analgesics.
      • Prevalence of headache was high.
      • Prevalence of long-standing, frequent, and disabling pain was high.
      • Participants had substantial concerns about their pain medication.

      Abstract

      Pain is a common reason for self-medication with over-the-counter (OTC) analgesics. However, this self-treating population has remained largely uncharacterized. This cross-sectional observational study investigated individuals who self-medicate their pain with OTC analgesics to elucidate their pain characteristics and medication use. In addition, presence of and risk factors for concerns about pain medication were examined. The clinical profile of the participants (n = 1,889) was worse than expected with long-standing pain complaints (median pain duration of 9 years), pain located at multiple body sites (median of 4, and 13% with ≥10 painful body areas), about one-third suffering from daily pain and about 40% experiencing substantial pain-related disability. Head (58.6% of sample), low back (43.6%), and neck (30.7%) were the most common pain locations. About 73% had a physician diagnosis, mainly migraine and osteoarthritis. Paracetamol (used by 68.6% of patients) and nonsteroidal anti-inflammatory drugs (46.8%) were the most frequently used pain medications. About 40% of our sample showed substantial concern about the perceived need for pain medication and the perceived potential for harmful effects (eg, fear for addiction). These findings highlight the importance for health professionals to systematically probe pain patients about their self-medication practices and explore attitudes about pain medication.
      Perspective: This study found that the clinical picture of people who self-medicate their pain with OTC analgesics looked worse than expected. We also identified substantial concerns about pain medication. Therefore, we recommend that health professionals systematically probe pain patients about their self-medication practices and explore concerns about pain medication.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bloudek LM
        • Stokes M
        • Buse DC
        • Wilcox TK
        • Lipton RB
        • Goadsby PJ
        • Varon SF
        • Blumenfeld AM
        • Katsarava Z
        • Pascual J
        • Lanteri-Minet M
        • Cortelli P
        • Martelletti P
        Cost of healthcare for patients with migraine in five European countries: Results from the International Burden of Migraine Study (IBMS).
        J Headache Pain. 2012; 13: 361-378
        • Carrasco-Garrido P
        • de Andres AL
        • Barrera VH
        • Jimenez-Trujillo I
        • Fernandez-de-Las-Penas C
        • Palacios-Cena D
        • Garcia-Gomez-Heras S
        • Jimenez-Garcia R
        Predictive factors of self-medicated analgesic use in Spanish adults: A cross-sectional national study.
        BMC Pharmacol Toxicol. 2014; 15: 36
        • Cevoli S
        • D'Amico D
        • Martelletti P
        • Valguarnera F
        • Del Bene E
        • De Simone R
        • Sarchielli P
        • Narbone M
        • Testa L
        • Genco S
        • Bussone G
        • Cortelli P
        Underdiagnosis and undertreatment of migraine in Italy: A survey of patients attending for the first time 10 headache centres.
        Cephalalgia. 2009; 29: 1285-1293
        • Collaborators GBD 2016 Disease and Injury Incidence and Prevalence
        Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016.
        Lancet. 2017; 390: 1211-1259
      1. European Brain Council. Value of treatment: Policy White Paper. Available at: http://www.braincouncil.eu/wp-content/uploads/2017/06/EBC_white_policy_paper_DEF26072017_Low.pdf

        • D'Amico D
        • Tepper SJ
        Prophylaxis of migraine: General principles and patient acceptance.
        Neuropsychiatr Dis Treat. 2008; 4: 1155-1167
        • Dale O
        • Borchgrevink PC
        • Fredheim OM
        • Mahic M
        • Romundstad P
        • Skurtveit S
        Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids.
        BMC Public Health. 2015; 15: 461
        • DeSalvo KB
        • Bloser N
        • Reynolds K
        • He J
        • Muntner P
        Mortality prediction with a single general self-rated health question: A meta-analysis.
        J Gen Intern Med. 2006; 21: 267-275
        • Diamond S
        • Bigal ME
        • Silberstein S
        • Loder E
        • Reed M
        • Lipton RB
        Patterns of diagnosis and acute and preventive treatment for migraine in the United States: Results from the American Migraine Prevalence and Prevention study.
        Headache. 2007; 47: 355-363
        • Eaves ER
        "Just Advil": Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain.
        Soc Sci Med. 2015; 146: 147-154
        • Foot H
        • La Caze A
        • Gujral G
        • Cottrell N
        The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis.
        Patient Educ Couns. 2016; 99: 706-717
        • Grezy-Chabardes C
        • Fournier JP
        • Dupouy J
        • Poutrain JC
        • Oustric S
        Patients' knowledge about analgesic-antipyretic medications purchased in community pharmacies: A descriptive study.
        J Pain Palliat Care Pharmacother. 2015; 29: 334-340
        • Gustavsson A
        • Svensson M
        • Jacobi F
        • Allgulander C
        • Alonso J
        • Beghi E
        • Dodel R
        • Ekman M
        • Faravelli C
        • Fratiglioni L
        • Gannon B
        • Jones DH
        • Jennum P
        • Jordanova A
        • Jonsson L
        • Karampampa K
        • Knapp M
        • Kobelt G
        • Kurth T
        • Lieb R
        • Linde M
        • Ljungcrantz C
        • Maercker A
        • Melin B
        • Moscarelli M
        • Musayev A
        • Norwood F
        • Preisig M
        • Pugliatti M
        • Rehm J
        • Salvador-Carulla L
        • Schlehofer B
        • Simon R
        • Steinhausen HC
        • Stovner LJ
        • Vallat JM
        • Van den Bergh P
        • van Os J
        • Vos P
        • Xu W
        • Wittchen HU
        • Jonsson B
        • Olesen J
        Cost of disorders of the brain in Europe 2010.
        Eur Neuropsychopharmacol. 2011; 21: 718-779
        • Horne R
        • Chapman SC
        • Parham R
        • Freemantle N
        • Forbes A
        • Cooper V
        Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the Necessity-Concerns Framework.
        PloS one. 2013; 8: e80633
        • Kaufman DW
        • Kelly JP
        • Rohay JM
        • Malone MK
        • Weinstein RB
        • Shiffman S
        Prevalence and correlates of exceeding the labeled maximum dose of acetaminophen among adults in a U.S.-based internet survey.
        Pharmacoepidemiol Drug Saf. 2012; 21: 1280-1288
        • Kernick D
        • Stapley S
        • Hamilton W
        GPs' classification of headache: Is primary headache underdiagnosed?.
        Br J Gen Pract. 2008; 58: 102-104
        • Lenert LA
        • Looman T
        • Agoncillo T
        • Nguyen M
        • Sturley A
        • Jackson CM
        Potential validity of conducting research on headache in internet populations.
        Headache. 2002; 42: 200-203
        • Margolis RB
        • Tait RC
        • Krause SJ
        A rating system for use with patient pain drawings.
        Pain. 1986; 24: 57-65
        • McCracken LM
        • Hoskins J
        • Eccleston C
        Concerns about medication and medication use in chronic pain.
        J Pain. 2006; 7: 726-734
        • Mehuys E
        • Paemeleire K
        • Crombez G
        • Adriaens E
        • Van Hees T
        • Demarche S
        • Christiaens T
        • Van Bortel L
        • Van Tongelen I
        • Remon JP
        • Boussery K
        The heterogeneity of headache patients who self-medicate: A cluster analysis approach.
        Pain. 2016; 157: 1464-1471
        • Pottegard A
        • Kviesgaard AK
        • Hesse U
        • Moreno SI
        • Hansen JM
        Patient characteristics among users of analgesic over-the-counter aspirin in a Danish pharmacy setting.
        Int J Clin Pharm. 2014; 36: 693-696
        • Sarganas G
        • Buttery AK
        • Zhuang W
        • Wolf IK
        • Grams D
        • Rosario AS
        • Scheidt-Nave C
        • Knopf H
        Prevalence, trends, patterns and associations of analgesic use in Germany.
        BMC Pharmacol Toxicol. 2015; 16: 28
        • Shiffman S
        • Rohay JM
        • Battista D
        • Kelly JP
        • Malone MK
        • Weinstein RB
        • Kaufman DW
        Patterns of acetaminophen medication use associated with exceeding the recommended maximum daily dose.
        Pharmacoepidemiol Drug Saf. 2015; 24: 915-921
        • Turner DP
        • Golding AN
        • Houle TT
        Using a graphical risk tool to examine willingness to take migraine prophylactic medications.
        Pain. 2016; 157: 2226-2234
        • Von Korff M
        • Ormel J
        • Keefe FJ
        • Dworkin SF
        Grading the severity of chronic pain.
        Pain. 1992; 50: 133-149
        • Wilcox CM
        • Cryer B
        • Triadafilopoulos G
        Patterns of use and public perception of over-the-counter pain relievers: Focus on nonsteroidal antiinflammatory drugs.
        J Rheumatol. 2005; 32: 2218-2224