The clinical profiles of patients taking over-the-counter (OTC) pain medications were found to be poorer than expected, with a high prevalence of migraine headache and many reporting frequent and disabling pain for extended durations, according to a study published in The Journal of Pain.

Pain is a major healthcare complaint and a leading cause of disability. Although the use of OTC analgesics for pain is common, there has been little characterization of the population resorting to these options in the literature. Investigators sought to fill this gap by characterizing individuals who self-medicate using OTC medications such as acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs), with the goal of improving patient care.

Between December 2012 and May 2013, individuals from Belgian community pharmacies who purchased a systemic OTC analgesic were recruited for this cross-sectional study. Participants were asked to report sociodemographic information, general state of health, and pain characteristics (location, diagnosis, duration, and frequency) using a questionnaire.

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Pain intensity and related disability over the previous 3 months were assessed using the 7-item Von Korff Pain Grading Scale (using an 11-point Likert scale for 6 of 7 items). Participants also reported all pain medications they were taking (OTC and prescription) and completed an adaptation of the Pain Medication Attitude Questionnaire (PMAQ), which addresses concerns regarding pain medications.

A total of 1889 pharmacy customers (mean age, 51.7 years; 74.8% women) were included in the analysis. Pain complaints were found to be longstanding (median duration, 9 years; >5 years for 60%), frequent (median number of days with pain, 36 over 3 months; 36.1% of participants with daily pain), and often reported at multiple locations (median number of locations, 4; 13.4% of participants with pain in ≥10 sites) in this cohort. Substantial disability as a result of pain symptoms was reported by 41% of study participants.

Headache was the most common location/complaint (58.6%), followed by low back pain (43.6%), and neck pain (30.7%). Physicians had diagnosed 73.4% of patients with a pain condition, of which the most frequent were migraine (31.5%) and osteoarthritis (16.3%). The most commonly used OTC medications were acetaminophen (68.6%) and NSAIDs (46.8%), with 27.8% reporting daily use.

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In terms of concerns related to OTC use, 40% of participants had fears involving the need for analgesics and/or the risk for harmful effects. This was particularly evident with regard to concerns about addiction and tolerance. Self-rated poorer health and higher disability levels were found to be correlated with greater concerns on the PMAQ.

Study strengths included a large sample size and the use of the PMAQ to evaluate patients’ concerns and attitudes.

Study limitations include possible recall bias for self-reports, use of a modified version of the PMAQ, lack of evaluation of clinician awareness regarding patient OTC use, and possible lack of generalizability to all individuals taking OTC analgesics, especially those in other healthcare systems with less accessibility.

“Based on our findings, we recommend that health professionals systematically and concretely probe pain patients about their self-medication practices (including dose and dosing frequency) and explore attitudes about pain medication in an open and nonjudgmental way at the initiation of therapy and during (long-term) follow-up,” noted the study authors.

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Mehuys E, Crombez G, Paemeleire K, et al. Self-medication with over-the-counter analgesics: a survey of patient characteristics and concerns about pain medication [published online September 28, 2018]. J Pain. doi:10.1016/j.jpain.2018.09.003