Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study

Abstract

ObjectiveFrequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain.DesignA cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA.Setting and participantsAll 10 608 adolescents aged 13–19 years in a region of Norway were invited in this school-based survey, participation rate was 76%.Outcome measureFrequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses.ResultsTrauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose–response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed.ConclusionTrauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.

“Nevertheless, it is still painful”: Use of Over-the-Counter analgesics, pain, stress, and HRQOL in Norwegian adolescents: a cross sectional study.

“…Our ndings show that those using OTCA to a high extent have more stress, this is in line with studies suggesting that some adolescents may resort to OTCA as a coping mechanism to deal with emotional or psychological stressors (34). Hence, it is important to acknowledge the possibility of bi-directional associations between stress and OTCA use.…”

“…The adolescents in the high user group have 30% increased risk for subjective intensity of pain on average. Also, previous studies show similar association between use of OTCA and pain (20,34). Not surprisingly, the high user group has higher odds of increased pain intensity (3,4) than the low user group (2,5).…”

Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study

“…27 Even short-term prescriptions increase the risk of persistent use and future misuse of potent analgesics, such as opioids, 1,35,36 and they should therefore be prescribed with great caution in all settings. 23,44 Overall, more frequent use of both opioid and nonopioid analgesics is linked to female sex, low socioeconomic status, pain in multiple sites, and psychological distress, 8,13,54,62,68,69 with prescriptions increasing sharply from midadolescence. 69 Although evidence is sparse, retrospectively assessed childhood interpersonal trauma, including sexual abuse, emotional abuse, and exposure to physical violence, has been found to be associated with using more analgesics.…”

“…9 Trauma types representing interpersonal violence, such as bullying, sexual abuse, and physical violence, and particularly multiple types of such trauma, have been found to be especially strongly associated with frequent use of over-the-counter analgesics. 8 Such cumulative load may be of importance for the relation to analgesics use also for other trauma types. 8 Childhood trauma is associated with pain, often in combination with functional impairment as well as psychological distress, with the latter representing an independent risk factor for chronic pain.…”

“…8 Such cumulative load may be of importance for the relation to analgesics use also for other trauma types. 8 Childhood trauma is associated with pain, often in combination with functional impairment as well as psychological distress, with the latter representing an independent risk factor for chronic pain. 3,5,15,72 Exposure to childhood trauma may therefore result in an increased risk of receiving prescription analgesics, including opioids.…”