The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study

Barros, Guilherme Antonio Moreira de; Calonego, Marco A. Marchetti; Mendes, Rannier F.; Castro, Raphael A.M.; Faria, João F.G.; Trivellato, Stella A.; Cavalcante, Rodney S.; Fukushima, Fernanda B.; Dias, Adriano

doi:10.1016/j.bjane.2019.10.006

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Scientific Articles • Rev. Bras. Anestesiol. 69 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.bjane.2019.10.006 copy

The use of analgesics and risk of self-medication in an urban population sample: cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics.

Method:

Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution.

Results:

416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids.

Conclusions:

The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.

KEYWORDS
Chronic pain; Analgesics; Self-medication; Urban population

Demographic data	Characteristics	CP presence		CP absence		Total
		n	%	n	%	n	%
Sex	Female	140^a a Percentage valid for each demographic data.	72.3	134^b b Information improperly completed on survey form or respondent refusal to report.	59.3	272	65.4
Sex	Male	50^a a Percentage valid for each demographic data.	27.4	92^b b Information improperly completed on survey form or respondent refusal to report.	40.7	144	34.6
Age group	18-39 years	46	24.2	71	31.4	117	28.1
	40-59 years	66	34.7	88	38.9	154	37.0
	60-69 years	43	22.6	33	14.6	76	18.3
	70-79 years	25	13.2	21	9.3	46	11.1
	> 80 years	10	5.3	11	4.9	21	5.0
	No information^b b Information improperly completed on survey form or respondent refusal to report.	0	0.0	2	0.9	2	0.5
Self-referenced skin color	White	141	74.2	182	80.5	323	77.6
	Non-white	49	25.8	41	18.2	90	21.6
	No information^b b Information improperly completed on survey form or respondent refusal to report.	0	0.0	3	1.3	3	0.7
Marital status	Married, cohabiting or stable union	120	63.2	125	55.3	245	58.9
	Single, separated or widowed	65	36.9	100	44.2	170	40.9
	No information^b b Information improperly completed on survey form or respondent refusal to report.	0	0.0	1	0.4	1	0.2
Education	Never studied	6	3.2	1	0.4	7	1.7
	Up to high school	132	69.5	135	59.8	267	64.2
	Up to college	38	20.0	72	31.8	110	26.4
	Postgraduate	12	6.3	18	8.0	30	7.2
	No information^b b Information improperly completed on survey form or respondent refusal to report.	2	1.0	0	0.0	2	0.5
Current work activity	Yes	96	50.5	122	54.0	218	52.4
	No	94	49.5	104	46.0	198	47.6
Total^c c Total corresponding to the population studied and not the sum of the data contained in column n. Different superscript letters on the same line represent p = 0.04.		190	45.7	226	54.3	416	100

Medical supervision		PC
Subjects under medical supervision	Medical specialty	n	%
	Orthopedics or rheumatology	47	47.0^a a Percentage valid for the number of subjects under medical supervision.
	Medical clinic	29	29.0^a a Percentage valid for the number of subjects under medical supervision.
	Pain	1	1.0^a a Percentage valid for the number of subjects under medical supervision.
	Others	17	17.0^a a Percentage valid for the number of subjects under medical supervision.
	Do not know	6	6.0^a a Percentage valid for the number of subjects under medical supervision.
Total subjects under medical supervision		100	67.1
Subjects without medical supervision		47	31.5
No information^b b Information improperly completed on survey form or respondent refusal to report.		2	1.3
Total subjects who practice or practiced self-medication		149	100.0

Pain intensity measured by numerical scale^a a Numerical scale from 0 to 10.	CP (n = 190) Mean ± SD
Highest intensity in last 24 hours	6.23 ± 2.81
Lowest intensity in last 24 hours	2.45 ± 2.23
Moderate intensity^b b Attributed by the subject himself. in last 24 hours	4.41 ± 2.44
Intensity at the moment	2.22 ± 2.78

	Analgesic Treatment(s)	CP (n = 190)
		n	%
Currently under treatment	NSAIDs, dipyrone or acetaminophen	92	48.4
	Muscle relaxant	36	18.9
	Physiotherapy	7	3.7
	Complementary medicine techniques	6	3.2
	Topical medicines	5	2.6
	Weak opioid	5	2.6
	Tricyclic or dual-action antidepressant	4	2.1
	Corticoids	3	1.6
	Physical activity	2	1.1
	Anticonvulsants^a a Anticonvulsants other than gabapentinoids or benzodiazepines.	2	1.1
	Gabapentinoids	1	0.5
	Psychotherapy	0	0.0
	Strong opioid	0	0.0
	Others	35	18.4
	Total subjects under treatment	142	74.7
Not currently using		48	25.3
Total		190	100.0

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
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[1] * Corresponding author. E-mail:guilherme.am.barros@unesp.br (G.A. Barros).