According to recent data, about 123 million prescriptions are filled each year for non-steroidal anti-inflammatory drugs (NSAIDs) in the United States. Data also show that approximately one-third of the general U.S. population has used over-the-counter NSAIDs. Despite widespread use of these drugs, little is known about the public’s experiences with pain and their understanding of these medications.
The “Understanding America’s Pain” survey queried 1,056 adults to gain a deeper understanding of the types of pain Americans are experiencing. The survey also looked at how pain impacts physical and emotional well-being, how respondents self-treated their pain, and their knowledge and general understanding about commonly used NSAIDs, including the risks associated with taking these drugs.
The survey found that the majority of Americans have experienced pain and that many believe their pain is not adequately controlled. About 77% experienced at least one form of pain, be it general, chronic, or pain resulting from aging, surgery, or injury. Another 43% experienced some form of pain at least weekly or more. Only 31% of respondents who experienced pain felt their pain was completely controlled.
The survey also delved into American’s understanding of NSAIDs, and showed that 47% did not know what NSAIDs were. Among those who said who knew what these medications were, many did not correctly identify common NSAID-containing medications, including naproxen, ibuprofen, and several brand-name pain killers.
The survey also revealed that only 48% of medication users reported being “very confident” that the medications they took were the safest and most effective for their pain symptoms. Nearly six in 10 Americans (58%) who used NSAIDs acknowledged that there are risks associated with them, but only 27% were aware of the FDA recommendations to use the lowest effective dose for the shortest duration. About half of respondents were unaware of low-dose pain medication options.
Importantly, the survey found that only 34% of those who had pain admitted that they typically ignored it. Furthermore, 58% reported not discussing how to manage pain with their doctor.
Addressing the Issue
Clinicians can help improve patient understanding of NSAIDs by explaining to patients that both over-the-counter and prescription forms of these drugs should be taken at the lowest effective dosage for the shortest duration that is consistent with individual treatment goals and as recommended by the FDA. The risk of serious cardiovascular, gastrointestinal, and renal adverse events associated with NSAID use are dose-related and can occur in as little as 1 week following initial dosage.
When managing patients with pain, healthcare professionals should ask questions about all medications being taken and explain that there are many options available to manage pain. Although time with patients is limited, healthcare providers have an important responsibility to empower patients with this knowledge.
Readings & Resources (click to view)
Kelton Global. Understanding America’s pain: identifying how Americans experience and manage pain. Available at: www.multivu.com/players/English/7755551-understanding-americas-pain/docs/white-paper-979369729.pdf.
McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011;8:e1001098.
Castellsague J, Riera-Guardia N, Calingaert B, et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012;35:1127-1146.
Huerta C, Castellsague J, Varas-Lorenzo C, García Rodríguez L. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis. 2005;45:531-539.
Koffeman A, Valkhoff V, Celik S, et al. High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study. Br J Gen Pract. 2014:64:e191-e198.
FDA. Public Health Advisory – FDA Announces Important Changes and Additional Warnings for COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Available at: www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm150314.htm.
Helin-Salmivaara A, Virtanen A, Vesalainen R, et al. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J. 2006;27:1657-1663.