The prevalence, knowledge, attitude and practice regarding self-administered over-the-counter analgesic use among patients with chronic musculoskeletal pain attending the Durban University of Technology Chiropractic Day Clinic
Authors:   , Engelbrecht Donna 
Published: August 2024

Chronic pain is a major concern globally, with the greatest contributor being chronic musculoskeletal pain (CMSP). CMSP decreases quality of life, affects activities of daily living, increases work absenteeism and health care expenses. Recommendations for the management of CMSP include exercise and the use of analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs), or more potent analgesics, including opioids. Amongst those suffering from CMSP, it is common to self medicate with analgesics. Over-the-counter (OTC) analgesics, in particular, help patients manage their own CMSP symptoms. However, OTC medicine use can be a problem when misused. The common reasons why patients self-medicate with OTC analgesics is the easy access to these medications; previous experience with treating their condition; and financial and economic difficulties, which prevent visiting a primary physician (for more potent analgesics), especially in developing countries. There are many studies that have examined the prevalence of self-medication of OTC analgesics using population-based studies and some among health science students at universities but these do not focus on the prevalence of self-medication among those with CMSP. There appears to be limited research conducted in South Africa with regards to the prevalence of self-administered OTC analgesic use among patients with CMSP, especially within a chiropractic clinic setting, where the treatment of CMSP consumes a large portion of primary care. It has also been noted in the literature that information and research needed to quantify the scale of misuse is currently lacking. Primary care physicians, including chiropractors, who more frequently treat chronic pain, are thus best suited to ascertain this by assessing the attitudes, knowledge and practices regarding self-administered OTC analgesic use amongst patients suffering from CMSP. Method This study is a quantitative, descriptive cross-sectional study, whereby a survey was conducted (using questionnaires) to collect data and make statistical inferences about the Chronic pain is a major concern globally, with the greatest contributor being chronic musculoskeletal pain (CMSP). CMSP decreases quality of life, affects activities of daily living, increases work absenteeism and health care expenses. Recommendations for the management of CMSP include exercise and the use of analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs), or more potent analgesics, including opioids. Amongst those suffering from CMSP, it is common to self medicate with analgesics. Over-the-counter (OTC) analgesics, in particular, help patients manage their own CMSP symptoms. However, OTC medicine use can be a problem when misused. The common reasons why patients self-medicate with OTC analgesics is the easy access to these medications; previous experience with treating their condition; and financial and economic difficulties, which prevent visiting a primary physician (for more potent analgesics), especially in developing countries. There are many studies that have examined the prevalence of self-medication of OTC analgesics using population-based studies and some among health science students at universities but these do not focus on the prevalence of self-medication among those with CMSP. There appears to be limited research conducted in South Africa with regards to the prevalence of self-administered OTC analgesic use among patients with CMSP, especially within a chiropractic clinic setting, where the treatment of CMSP consumes a large portion of primary care. It has also been noted in the literature that information and research needed to quantify the scale of misuse is currently lacking. Primary care physicians, including chiropractors, who more frequently treat chronic pain, are thus best suited to ascertain this by assessing the attitudes, knowledge and practices regarding self-administered OTC analgesic use amongst patients suffering from CMSP. Method This study is a quantitative, descriptive cross-sectional study, whereby a survey was conducted (using questionnaires) to collect data and make statistical inferences about the indicated that they use their own experience of what helps relieve their pain; a further number (39.3%) indicated that they read the information insert inside the medication box. The percentages do not add up to 100% because the participants had chosen more than one option in the question. Regarding the number of participants who responded to the use of different analgesics, most participants (70.3%) were using NSAIDs; followed by paracetamol only (57.7%); combination analgesics not easily obtainable without a prescription (54.1%); combination analgesics that can be obtained without prescription (41.1%); aspirin (15.3%) and other (0.9%). It was determined that more participants (66.7%) indicated that they did not experience any side effects from the analgesics that they were consuming (p<.001). Gender has shown to have an influence on self-administered analgesic use. It was found that there was a significantly larger number of females (86.2%) who used self-administered analgesics compared to males (69.1%) (p=.001). The age group 35–44 was found to be statistically more likely to use self-administered painkillers (88.9%), followed by those aged 65+ (88%) (p=0.48). A significant number of Black participants (p=0.43) indicated that they did not use self administered OTC analgesics (29.1%) and a significant number of participants who indicated “Other” also did not use self-administered OTC analgesics (44.4%) (p=0.43). Conclusion The findings from this study reinforce that primary care physicians, including chiropractors, need to take better initiatives in educating, providing better guidelines and promoting safe and effective OTC analgesic use to their CMSP patients. Considering that this study demonstrated a high prevalence of CMSP, and a high prevalence of OTC analgesic use, it is important that chiropractors understand patients with chronic pain and why they may make certain decisions. Seeking additional pain relief options like chiropractic treatment for CMSP earlier may help reduce reliance on OTC analgesic medication.