Use Of Over-the-counter Analgesics Research Articles

Associations between over-the-counter analgesics usage and symptoms of anxiety and depression in adolescents: a network analysis

BackgroundThe use of over-the-counter analgesics (OTCA) is common among adolescents and has been linked with increased symptoms of anxiety and depression. However, little is known about which specific symptoms are most strongly connected to OTCA usage. The current study assessed which anxiety and depression symptoms were most closely associated with OTCA usage in a large sample of adolescents and examined whether this differed across genders.MethodThe present study was based on data from 626,581 participants from the Ungdata survey in Norway. Associations between OTCA and anxiety and depression symptoms were examined using network analysis. Non-regularized partial-correlation networks were constructed to estimate the conditional dependent relations between the use of OTCA and symptoms while controlling for pain. Gender-specific networks were created for comparison.ResultsOTCA usage was associated with most symptoms, even after controlling for pain, with the strongest associations with “sleep problems”, “stiff or tense”, “everything is a struggle” and “suddenly scared”. There were some gender differences, showing that “sleep problems” and “hopeless” were more strongly related to OTCA usage in females, whereas “stiff or tense” was more strongly related to OTCA usage in males.ConclusionOverall, the somatic symptoms of anxiety and depression displayed the strongest associations with OTCA usage. When examining the gender-specific networks, both showed similar trends, although males exhibited slightly stronger associations between OTCA usage and somatic symptoms.

The use of youth healthcare services and its association with health-related quality of life, physical and mental health and over-the-counter analgesics use in 13–19-year-old adolescents: a cross-sectional study

BackgroundYouth healthcare services in Norway include a public health nurse (PHN) at school and local youth health centres (YHCs). They provide health services for all adolescents free of charge, focusing on health promotion and disease prevention. The present study aimed to assess possible associations between health-related quality of life (HRQoL), physical and mental health, over-the-counter analgesics (OTCA) use and use of youth healthcare services among 13–19-year-old adolescents.MethodsThis study was based on national, cross-sectional data from the Ungdata Survey conducted in 2022. The sample was comprised of 16 482 adolescents. Multiple logistic regression was used to analyse the associations between HRQoL, headaches, selected physical symptoms, psychological distress, use of OTCA, PHN availability, sociodemographic variables, and use of the PHN at school or at a YHC. The KIDSCREEN-10 was used to measure HRQoL, and the Hopkins Symptoms Checklist 10 was used to measure symptoms of psychological distress.ResultsGirls used the youth healthcare services more frequently than boys. Better HRQoL was significantly associated with fewer visits to the PHN at school. Girls reported lower HRQoL and mental health, and more pain and frequent OTCA use than boys. When having symptoms of psychological distress, boys had greater odds of visiting the PHN at school than girls. For girls in senior high school, headaches and OTCA use were strongly associated with visiting the PHN at school and the YHC. In senior high school, boys with an immigration background had greater odds of visiting the YHC than native Norwegian boys, while girls with an immigration background were less likely to visit the YHC than native Norwegian girls.ConclusionsOur results show that more girls than boys use youth healthcare services. When adolescents experience pain, have mental problems, use OTCA, or report low levels of HRQoL, they have greater odds of using youth healthcare services. Youth healthcare services offer excellent opportunities to support and follow up with adolescents. The findings provide important insights into youth healthcare services used by adolescents for various stakeholders, including PHNs and policy makers, with potential implications for future public health efforts.

Use patterns of over the counter analgesics in adult population in United Arab Emirates: A Population Based Study

Background: Analgesics are among the most commonly used over the counter (OTC) medications and are widely available. Yet, their use patterns are not well documented. This study aimed to assess the self-use of OTC analgesics and use patterns in the adult population of the United Arab Emirates. Methods: A descriptive cross-sectional survey was conducted in Dubai and Sharjah Emirates among adults aged 18 years and over who were not from healthcare professions. We further conducted a multivariable logistic regression to investigate the factors associated with the use of paracetamol as OTC analgesic. Results: In total, 604 individuals fulfilled the inclusion criteria and answered the survey. Overall, 350 of respondents (58%) were women. The most commonly used analgesic was paracetamol either alone or in combination (n=459, 76%); headache was the main cause for use. Most respondents self-used OTC analgesics less than once a month (n=332, 55%). The majority of respondents (n=314, 52%) never read the patient information leaflets and one-tenth reported taking more than two tablets at once. Use of paracetamol was less common in men compared to women (adjusted odd ratio (aOR) 0.57, 95% confidence Interval (CI) 0.40-0.83) while it was more common in persons with a chronic condition (aOR 1.69, 95%CI 1.15-2.49). Conclusion: Considering that paracetamol and other non-steroidal anti-inflammatory drugs are widely used and easily available in retail sales and online, and since most users do not read the patient information leaflets, pharmacists can have an important role in educating patients for the rational use of OTC analgesics and to avoid their overuse.

Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study

Frequent and increasing use of over-the-counter analgesics (OTCA) is a public health concern. Pain conditions and psychological distress are related to frequent OTCA use, and as exposure to potentially traumatic events (PTE) in childhood appears to increase risk of experiencing such symptoms, we aimed to assess childhood PTEs and related symptoms in adolescence as predictors for frequent OTCA use in young adulthood. Prospective population survey data were used (n = 2947, 59.1% female, 10–13 years follow-up). Exposure to PTEs, symptoms of post-traumatic stress, anxiety and depression, musculoskeletal pain and headache were assessed in adolescence (13–19 years). Use of OTCA was assessed in young adulthood (22–32 years) and use of OTCA to treat musculoskeletal pain and headache served as separate outcomes in ordinal logistic regression analyses. Overall, exposure to childhood PTEs, particularly direct interpersonal violence, was significantly and consistently related to more frequent use of OTCA to treat musculoskeletal pain and headaches in young adulthood. Adjusting for psychological symptoms and pain attenuated associations, indicating that these symptoms are of importance for the relationship between traumatic events and OTCA use. These findings emphasize the need to address symptomatology and underlying causes at an early age.

Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study

ObjectiveFrequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of...

A national initiative to promote public involvement in medicine safety in Scotland: the use of a population survey to identify candidate behaviours for intervention development

Abstract Introduction Medicines are the most commonly used healthcare intervention (1). Every medicine has benefits and harms. One of the five objectives of the WHO Global Patient Safety campaign, Medication Without Harm, is to “empower patients, families and their carers to become actively involved and engaged in treatment or care decisions, ask questions, spot errors and effectively manage their medications” (2). Effective strategies are needed to promote greater public involvement in the safe and effective use of medicines. Aim The aim of this study was to explore the prevalence of public behaviour in terms of information-/advice-seeking about medicines in general, newly prescribed medicines, and pain management including their use of oral, over-the-counter (OTC) analgesics. The survey also included exploration of self-reported behaviour regarding their use of pharmacies and OTC analgesics. Methods A cross-sectional online survey of 1000 adults (aged >16years) in Scotland was undertaken in collaboration with Ipsos MORI. The content was informed by a multi-stakeholder prioritisation event (held in November 2019) and supplemented with information from earlier studies, including national surveys using Citizen Panels. The following themes were included in the questionnaire: The data were input online by respondents then cleaned and weighted by Ipsos Mori using random iterative method (RIM) weighting to the known offline population proportions for age, gender, region and working status. All data were analysed and presented using descriptive statistics. Results Most respondents (78%, n=777) had used a pharmacy in the previous 12 months to obtain a prescription medicine and slightly fewer (61%, n=610) to obtain an OTC medicine. Low levels of information- and advice-seeking were reported especially on receipt of new prescription medicines. Few (5%) respondents ‘always’ discussed their new prescription medicine with pharmacy staff and 29% reported ‘never’ engaging in this behaviour. Older people (> 35 years) were less likely to engage in this behaviour. Up to 65% of respondents reported ‘always’ engaging with specific aspects of the appropriate use of OTC analgesics e.g. appropriate dose. Potentially unsafe behaviours were identified with medicine disposal. Nearly one third (29%) of respondents considered waste bin disposal to be of low or no harm, and 19% considered disposal of medicines via the toilet/sink to be of low/no harm. Conclusion Despite the extensive use of pharmacies, low levels of information-/advice-seeking were reported especially on receipt of new prescription medicines. Potentially unsafe behaviours were also identified with medicine use and disposal. The key determinants of these behaviours will be explored in more detail and theory-based interventions will be developed and tested to evaluate their effect. Respondent opinion (positively or negatively) regarding their perceptions regarding community pharmacies and/or pharmacy personnel could have been influenced by the increased use and/or awareness of community pharmacy services due to the pandemic. References (1) National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE Guidelines [NG5]. 2015. https://www.nice.org.uk/guidance/ng5 (accessed 13/10/2021). (2) Medication without harm - Global patient safety challenge on medication safety. Geneva: World Health Organization, 2017. Licence: CCBY-NC-SA3.0IGO.

Generic versus brand-name over-the-counter analgesics: knowledge and attitudes among Swedish pharmacy customers

BackgroundDue to a liberalisation reform in 2009, the availability of over-the-counter (OTC) analgesics has increased significantly in the Swedish market over the past decade. With the increasing number of generic products available on the market and the possibility of buying OTC drugs from non-pharmacy outlets, a key to safe drug use is that consumers possess the necessary knowledge to differentiate between the different brands and choose the appropriate drug for their ailments. The aim of this study was to investigate Swedish consumers’ knowledge of and attitudes towards generic OTC analgesics.MethodsA sample of 209 Swedish adults (66% women; mean age 43.1 years) who bought OTC analgesics at a community pharmacy in one of the country’s three largest cities responded to a structured questionnaire. The questions related to knowledge of active substances, the use and choice of OTC analgesics (generic or original brand), attitudes towards generic OTC analgesics, information received about OTC analgesics and experience with generic substitution of prescription drugs.ResultsAlmost one in five reported weekly use of OTC analgesics, and 32% assigned minimum three out of four active substances to the correct brand(s) of OTC analgesics. Among the 50 participants (24%) who assigned all four active substances correctly, it was predominantly women and participants with higher education. Four out of five participants were positive towards the cheaper brands, and 69% reportedly chose cheaper generic brands over more expensive brands. Knowledge about the active substances of different brands was associated with positive attitudes towards generic products.ConclusionSwedish pharmacy customers have to a varying extent the knowledge to differentiate between different brands of commonly used OTC analgesics in terms of active substances. There is a predominantly positive attitude towards generic OTC analgesics, although some consider generic drugs to be inferior and stay loyal to the original brands.

How do parents influence their adolescents’ use of over‐the‐counter analgesics: A review of the current literature

Continuous use of over-the-counter analgesics (OTCAs) may prevent adolescents from learning healthier options and might lead to lifelong use of such medicines. It is possible that parents' own use of OTCAs might influence adolescents, but little is known about this issue. Our research questions were; "What are the main factors leading to a high use of OTCAs among adolescents and how can health professionals support these adolescents in their pain management?" Frequent consumption of OTCAs may cause health problems such as drug-induced headache and liver failure. Some adolescents frequently use non-prescribed pain medication and their attitudes towards the use of OTCAs vary from responsible to careless. A "systematic search and review" was conducted between March 2017 and May 2018. Quantitative and qualitative studies were included. We used the PRISMA Statement checklist, the PRISMA flow diagram and The Critical Appraisal Skills Programme for quality appraisal. Our search identified 3,386 possible sources, 2,043 articles were selected for title examination, and 70 articles underwent abstract review. Fourteen articles were reviewed entirety. Ten articles were of acceptable quality. The importance of parental influence on adolescent use of OTCAs is significant. These findings seem to be independent of country and culture. Parents are the most important source of information regarding the use of OTCAs; further, they are the main supplier of the medicine. A broad understanding of human development, health, pain and use of pain medication is needed to develop targeted information and support adolescents with high consumption of non-prescription pain medication. Information from professionals such as school nurses is important. Professionals must consider the physical, social and psychological aspects influencing the use of OTCAs. Information should be made available to adolescents, parents and society in general.

P157: Pain management post-emergency department discharge: how are analgesics being consumed by patients with ongoing pain?

Introduction: Pain management is a cornerstone of emergency department (ED) practice, yet ongoing pain after ED discharge and return visits for inadequate analgesia are common. Over-the-counter (OTC) acetaminophen and nonsteroidal anti-inflammatory drugs are widely accepted first line agents for mild to moderate pain. Previous research has not investigated how patients actually consume such agents after discharge, and if they consume them synergistically and at sufficient doses for optimal analgesia. We sought to determine the proportion of patients in ongoing pain post-discharge that were utilizing analgesics as well as the type and dose of agent(s) used. Methods: Adults presenting to our ED with an acutely painful musculoskeletal complaint during research assistant hours were eligible for enrollment. After excluding non-English speakers as well as admitted, pregnant/breastfeeding, and chronic pain patients, consenting subjects completed in-person questionnaires during their ED stay and a follow-up telephone interview 2-3 days later. Results: 158 individuals were approached during the study period, of which 99 enrolled. 78 completed follow-up. At follow-up, 71 (91%) individuals experienced ongoing pain with a median score of 5 (interquartile range (IQR) 3-6) on an 11-point scale. 48 (67%) of patients still in pain consumed analgesics in the preceding 24 hours. The most commonly used agents were acetaminophen by 18 individuals (38% of analgesic users), ibuprofen by 16 (33%), and naproxen by 9 (19%). 29 respondents (60% of analgesic users) were using solely oral OTC analgesics. Only 15 (31% of analgesic users) used multiple agents concurrently, and 11 (23%) used prescription opioids. Acetaminophen was used at a median daily dose of 1500mg (IQR 1000-2000mg), much lower than that recommended for maximal analgesia (4000mg). Ibuprofen daily doses (1200mg, IQR 800-1300mg) were slightly lower than typical recommended doses (1600mg, 400mg every 6 hours). Conclusion: Only two-thirds of patients with ongoing pain at 2-3 days post-ED discharge were consuming analgesics, most commonly acetaminophen and ibuprofen. Of patients using analgesics, less than one-third used multiple agents. OTC medications are not used by most patients at doses for maximal analgesia. It may be possible to reduce pain burden and repeat-visits in discharged ED patients by optimizing the use of OTC analgesics.

Over-the-Counter Analgesics: What Nurse Practitioners Need to Know

Many patients and health care practitioners are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications and in certain patient populations. Recently, there has been a call from the United States Food and Drug Administration, consumer groups, and specialty medical groups for safer use of OTC analgesics. This article reviews the more common OTC analgesics, mechanisms of action, potential drug interactions, and approach to patient management, with consideration of special patient groups.

Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids.

BackgroundThere are concerns about potential increasing use of over-the-counter (OTC) analgesics. The aims of this study were to examine 1) the prevalence of self-reported use of OTC analgesics; 2) the prevalence of combining prescription analgesics drugs with OTC analgesics and 3) whether lifestyle factors such as physical activity were associated with prevalence of daily OTC analgesic use.MethodsQuestionnaire data from the Nord–Trøndelag health study (HUNT3, 2006–08), which includes data from 40,000 adult respondents. The questionnaire included questions on use of OTC analgesics, socioeconomic conditions, health related behaviour, symptoms and diseases. Data were linked to individual data from the Norwegian Prescription Database. A logistic regression was used to investigate the association between different factors and daily use of paracetamol and/or non-steroid anti-inflammatory drugs (NSAIDs) in patients with and without chronic pain.ResultsThe prevalence of using OTC analgesics at least once per week in the last month was 47%. Prevalence of paracetamol use was almost 40%, compared to 19% and 8% for NSAIDs and acetylsalicylic acid (ASA), respectively. While the use of NSAIDs decreased and the use of ASA increased with age, paracetamol consumption was unaffected by age. Overall more women used OTC analgesics. About 3-5% of subjects using OTC analgesics appeared to combine these with the same analgesic on prescription. Among subjects reporting chronic pain the prevalence of OTC analgesic use was almost twice as high as among subjects without chronic pain. Subjects with little physical activity had 1.5-4 times greater risk of daily use of OTC compared to physically active subjects.ConclusionsUse of OTC analgesics is prevalent, related to chronic pain, female gender and physical inactivity.

Drug Interactions of OTC Analgesics-Aspirin: A Review

Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin is one of the most important medicines required in basic health care system. The possibility of drug interactions with concomitant use of multiple medications is a clinically relevant issue. Many patients are unaware that over-the-counter (OTC) analgesics can cause potentially severe adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin significantly increased risk of upper abdominal gastrointestinal adverse events in patients who take traditional nonsteroidal anti-inflammatory drugs (NSAIDs). This risk is dose dependent and additional increased in patients who take more than one NSAID or use NSAIDs in combination with certain other medications. Some NSAIDs may also alleviate the antiplatelet benefits of aspirin and may increase blood pressure in patients with hypertension. Clinicians should be aware of potential drug interactions with OTC analgesics when prescribing new medications. Additionally, patients should be properly counseled on the appropriate and safe use of OTC analgesics and make sure that they know the benefits as well as the potential risks of both prescription and overthe-counter medications they are taking.

Association of Maternal Self-Medication and Over-the-Counter Analgesics for Children

Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child's frequency of pain into account. A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use. After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child's pain was adjusted for (odds ratio 3.00, P = .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics. Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child's pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.

OTC analgesics and drug interactions: clinical implications

The risk of drug interactions with concurrent use of multiple medications is a clinically relevant issue. Many patients are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents. Of particular significance is the increased risk of upper abdominal gastrointestinal adverse events in patients who take traditional nonsteroidal anti-inflammatory drugs (NSAIDs). This risk is dose dependent and further increased in patients who take more than one NSAID or use NSAIDs in combination with certain other medications. Some NSAIDs may also mitigate the antiplatelet benefits of aspirin and may increase blood pressure in patients with hypertension. Clinicians should be aware of potential drug interactions with OTC analgesics when prescribing new medications. Additionally, patients should be properly counseled on the appropriate and safe use of OTC analgesics.

Effect of Reading Additional Safety Information on Planned Use of Over‐the‐Counter Analgesics

This study was used to test the effect on planned safe use of over-the-counter (OTC) analgesics of adding information about the potential for nonsteroidal anti-inflammatory drug (NSAID) interaction with antihypertensive medications, the potential for interaction of alcohol and acetaminophen, and NSAID ceiling effects to the Federal Drug Administration's (FDA's) OTC analgesics pamphlet. A randomized posttest-only double-blind experimental design was used to test an intervention with a comparison group reading the FDA pamphlet, and treatment group reading the pamphlet with added information. Participants included 137 adults. Participants read the treatment or the comparison pamphlet. Both groups responded with similar planned use of OTC analgesics. The majority were likely to read the label before taking an OTC analgesic, but were unlikely to give acetaminophen to a family member using antihypertensive medication. Reading additional information about OTC analgesics resulted in no greater intention to safely use analgesics. Responses indicated reluctance to use OTC analgesics, and the potential need for increased health teaching regarding use of OTC analgesics with antihypertensive medication. Public health teaching should include the importance of treating pain and selecting the safest OTC analgesics for the clinical situation.

How 'fast' is over-the-counter (OTC) pain relief?

Background The onset of action of OTC analgesics compared to placebo is generally detected by 30 minutes in clinical trials. Based on their experience with OTC analgesics, consumers may have a different understanding of “onset” and which time span is “fast.” Therefore, we asked them. Methods We used our piloted questionnaire1 to interview a convenience sample of 170 consecutive adults (ca. the same number selected for a clinical trial) who had a history of using an OTC analgesic drug to treat non-specific non-daily headaches (the main use of OTC analgesics). We asked them questions about when a pain-relieving tablet medicine is “beginning to work for your headache.” Results Approximately 40% considered onset within 15 minutes indicative of working “fast” to relieve headache, 89% within 30 minutes (median and mode: 20 minutes). It would take a difference of at least 5 minutes for most of them to say that one drug begins to provide relief “faster” than another drug; ca. 70% reported a requisite difference of at least 10 minutes. Conclusions These findings indicate, reassuringly, that consumers' understanding of an OTC drug's onset of action for headache coincides with the pharmacodynamic properties of OTC analgesics observed in clinical trials. They suggest that “patient-determined” criteria like these (for onset of action) may enhance our ability as investigators to measure and interpret patients' responses in clinical trials. Clinical Pharmacology & Therapeutics (2005) 77, P52–P52; doi: 10.1016/j.clpt.2004.12.090

Television and Adolescent Use of Over-the-Counter Analgesic Agents

Portrayals of the use of over-the-counter (OTC) analgesics on television may stimulate their use. To explore the association between taking OTC analgesics and television viewing by adolescents. A standardized self-administered questionnaire among first-year (mean age 13.16 y) and fourth-year (mean age 16.37 y) secondary students in Flanders, Belgium (n = 2546) was administered in a school setting. The independent variable was television viewing; control variables were school year, gender, drinking alcohol, days off sick, computer gaming, and Internet use. The main outcome variable was monthly use of OTC analgesics. On average, respondents watched 3 hours 18 minutes of television per day (boys more than girls, first-year students more than fourth-year students). Per additional hour of television per day, the odds that respondents were regular users of analgesics were 1.16 times higher (95% CI 1.08 to 1.24). For the 10% heaviest viewers, the odds were 2.30 times higher (95% CI 1.25 to 4.24) compared with the 10% lightest viewers. Odds of OTC analgesic use were higher for students reporting more sick days in the past year (OR 1.38, 95% CI 1.28 to 1.49), regular users of alcohol (OR 1.33, 95% CI 1.17 to 1.50), and girls (OR 1.92, 95% CI 1.35 to 2.73). A relationship was found between watching television and the use of OTC analgesics, even after controlling for gender and lifestyle measures. More research is needed to establish whether this relationship is causal.