Patterns of use and public perception of over-the-counter pain relievers: Focus on nonsteroidal antiinflammatory drugs

Objective. To assess the frequency and indications for over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) use and to what degree the public is aware of their side effects. Methods. Two surveys totaling 9062 respondents were performed of the American public. The Roper survey, conducted in 1997, and the National Consumers League (NCL) survey, conducted in December 2002, were intended primarily to assess the public's use of and attitudes toward NSAID and OTC analgesics. Results. Ibuprofen based drugs were the most frequently used OTC in both surveys (57% Roper, 33% NCL). In the Roper survey, 17% of respondents used NSAID, with 38% using both prescription and OTC. Forty-six percent of exclusive OTC users believed OTC were safer, while 56% of exclusive users of prescription NSAID believed they were safer. Sixty percent and 29% of exclusive OTC users were neither aware of nor believed they were at risk for side effects from NSAID, respectively. Twenty-six percent of respondents used more than the recommended dose on the label, while 22% believed warning symptoms would always precede any NSAID induced complications. In the NCL survey, 83% had used an OTC agent in the last year, with 15% reporting daily use, and 49% were not concerned about potential side effects. In this survey, 30% believed there was less risk with OTC analgesics, and 44% consumed more than the recommended dosage on the label. Conclusion. OTC analgesics including NSAID are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects. Educational intervention directed toward both patients and physicians appears warranted.