OTC Analgesics Help Patients Avoid Stigma

Physicians need to be approachable, nonjudgmental, and informed about all OTC treatments their patients are taking.

Patients rely on over-the-counter (OTC) pain relievers to avoid the opioid-abuse stigma of chronic pain, according to a study published in the December 2015 issue of Social Science & Medicine.1

Analyzing data from 271 interviews, Emery Eaves, PhD, also found that patients with chronic pain deem OTC analgesics a safer alternative to prescription drugs because they are readily available.

Indeed, sales of internal analgesics in 2014 were $3.912 billion, up from $3.849 billion in 2013, according to the Consumer Healthcare Products Association.2

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The relative ease of access consumers have to these medicines signals that they are relatively harmless and justifies regular consumption, Dr. Eaves, a postdoctoral research associate from the University of Arizona College of Medicine in Tucson, Arizona, told Clinical Pain Advisor.

“It may be important for (clinicians) to know that people with pain might be using considerable amounts of these OTC medications that they have not mentioned,” Dr. Eaves said, pointing out that any prescription drug interactions with ibuprofen, acetaminophen, and other OTC medications should be clearly explained.

Ian Coulter, PhD, concurs, noting that clinician attitude is also important.

Physicians need to be approachable, nonjudgmental, and informed about all OTC treatments their patients are taking — from herbal supplements to pain medications, Dr. Coulter told Clinical Pain advisor, noting that additional studies are needed to determine optimal methods of impacting patient behavior with respect to use of non-prescription drugs.

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For the study, Dr. Eaves recruited 95 participants from a large randomized trial of traditional Chinese medicine for chronic temporomandibular joint (TMJ) pain.3

A total of 271 semi-structured qualitative interviews were conducted over a 5-year period from 2006 to 2011. The interviews were designed to elicit a broad range of experiences related to living with pain, including beliefs about illness and healing, family and social support, experience of stereotypes, expectations and hopes for treatment, and pain tolerance.

Results showed that only 10% of patients reported regular use of opioid medications; most chose not to use prescription medications at all, or to use them sparingly regardless of pain severity. Reasons included the need to monitor pain to avoid further damage; the desire to save medication for when it was really needed; a perception that efficacy would decrease over time; concerns over being able to function normally; and the potential for addiction.

In contrast, reports indicated widespread use of OTC analgesics, including ibuprofen (89%), acetaminophen (53%), naproxen (35%), and aspirin (20%). Patients described their use of OTC pain medications as minimal, responsible, and justified by the severity of their pain. Though they reported often exceeding the recommended dosage, most remained unclear as to the potential for consequences.