Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway

Abstract

Background Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use. Methods This study included 349,528 adolescents aged 13–19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies. Results Thirty percent of females and 13 % of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain. Conclusions Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.

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

“…Close to 10% of the adolescents in our study reported using OTCA for headache weekly or daily and 3.5% reported use for musculoskeletal pain weekly or daily. These findings comply with previous studies showing that a substantial subgroup of adolescents use OTCA frequently 2 4 10. Such weekly use will generally represent overuse and may have negative health effects 11 43…”

“… 2 4 56 In terms of depression and anxiety, these conditions have been found to be associated with using OTCA more frequently also after adjusting for pain. 4 There is also an overlap between social factors related to trauma and to chronic pain, including a less favourable family environment and poorer peer relational skills. 49 Thus, it is plausible that physiological and psychological trauma reactions and related social problems may contribute to more frequent use of OTCA among trauma-exposed adolescents.…”

“…Over-the-counter analgesics (OTCA) are commonly used among adolescents, [1][2][3][4] and use appears to have increased over the past decades. 1 In studies on adolescents, it is consistently found that girls use more pain medication than boys, and that analgesic use increases from early to late adolescence.…”

Killing pain?: a population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among all children, adolescents and young adults in Norway from 2004 to 2019

“…Still, as cancer survivors comprise about 0.5% of the child population and most survivors do not require long-term pain management, this cannot fully explain the overall increase in prescription analgesics use [ 55 ]. This leaves the possibility that conditions which do not indicate use of pain medication that seem to be increasing in younger age groups, such as chronic pain or psychological distress, may have contributed to higher use of prescription analgesics [ 24 , 27 , 41 ].…”

Medication Safety in Municipal Health and Care Services

“…Sales of paracetamol are second on the OTC list. A Norwegian study showed that 30% of female and 13% of male adolescents aged 13-19 use OTC analgesics weekly (Jonassen et al, 2021). Daily use of paracetamol, even in small doses, can give rebound headaches (Fischer & Jan, 2021).…”