ANALGESIC AVOIDANCE IN JAPAN: AN EPIDEMIOLOGICAL STUDY EXPLORING ATTITUDES TOWARD MENSTRUAL PAIN AND MEDICATION
Authors: Yamada *Keiko , Yamaguchi Sakiko , Mizunuma Naoki , Takeda Takashi 
Published: February 2025

Abstract

Background
In Japan, 'addiction' is highly stigmatized, leading to the avoidance of analgesics due to concerns about addiction (Purnell 2019). Furthermore, there is a cultural belief in Japan that emphasizes enduring pain as a virtue (Purnell 2019). These cultural contexts related to pain contribute to attitudes toward analgesics in Japan.

Aims & Objectives
This study aimed to investigate the situation among Japanese women who do not use any analgesics for menstrual pain, concerning their avoidance of analgesics and fear of dependence. Additionally, the study aimed to examine the pain endurance practices among women who engage in self-medication for menstrual pain using over-the-counter (OTC) analgesics.

Method
All participants provided their web-based informed consent before responding to the online questionnaire. The Ethics Committee at Juntendo University Faculty of Medicine approved this study (approval number E22-0469-M02). We analyzed data from a cross-sectional web survey with self- reported questionnaires conducted in 2023 among Japanese women experiencing menstruation. The study included 557 women who did not use analgesics and 1284 women who exclusively used OTC analgesics for menstrual pain, after excluding potential confounding factors and other relevant variables. For women who did not use analgesics, we asked about their concerns regarding menstrual pain, reasons for not using pain relievers, and other related questions. For women who used OTC analgesics, we used a numerical rating scale (NRS) to assess pain threshold they deemed acceptable without analgesics and explored other pertinent factors.

Results
Of 557 women who did not use analgesics, 365 women (65.5%) were actually concerned with menstrual pain. For the 365 women who were concerned about menstrual pain but did not use analgesics, the reasons for not using analgesics are as follows: 15.3% of the women believed they should endure the pain, 15.1% thought analgesics are harmful to their health, and 40.6% fear that they might become dependent on them. The median number of analgesics was 2.0. Of the 1284 women who used analgesics, 47.1% believed that they should endure menstrual pain up to an NRS of 5 or higher, while 4.1% believed they should endure it up to an NRS of 8 or higher.

Discussion & Conclusion
This study represents the first epidemiological research in Japan that investigates the reasons behind analgesic avoidance for menstrual pain and the belief that one should endure pain without using analgesics for menstrual pain. Surprisingly, among women who actually experience concerns about menstrual pain, approximately 40% refrain from using analgesics due to fear of potential dependence. Additionally, about half of those who use analgesics for menstrual pain believe that they should only use them when their pain reaches an NRS of 5 or higher. It is important to suggest that excessive fear of using analgesics for menstrual pain is unnecessary, and that using analgesics appropriately can make menstrual discomfort more manageable.

References
Purnell, L.D. and Fenkl, E.A. (2019). People of Japanese heritage. In: Purnell, L. (ed.), Handbook for Culturally Competent Care, 1st edn. Springer Nature, New York.