Factors that influence how adults select oral over-the-counter analgesics: A systematic review

Oral over-the-counter (OTC) analgesics such as acetaminophen, aspirin, ibuprofen, and naproxen sodium are widely used to treat pain. Although generally considered safe, inappropriate use can lead to injury.

This study aimed to explore patient attitudes, beliefs, and perceptions about the efficacy and potential risks of oral OTC analgesics and to identify factors that adult patients use to make decisions about these medications.

We searched MEDLINE, CINAHL, Scopus, and Embase to identify studies published in English between January 2000 and June 2019. We included randomized controlled trials, controlled trials, observational studies, systematic reviews, and meta-analyses that included OTC analgesics. Authors worked independently during study selection, data extraction, and analysis and then compared their findings and discussed discrepancies until consensus was reached. We evaluated study quality using the Study Quality Assessment Tool and Critical Appraisal of a Cross-Sectional Study.

We identified 10,898 unique articles, of which 53 were included in this systematic review. A total of 36 studies included acetaminophen, 25 included nonsteroidal anti-inflammatory drugs (NSAIDs), and 19 did not specify a product. Adults had mixed perceptions about the effectiveness of analgesics. Knowledge of the risks of high doses of acetaminophen (liver toxicity) and NSAIDs (gastrointestinal bleeding or nephrotoxicity) was generally low and declined with less formal education. Individuals with severe or recurrent pain were more likely to exceed the maximum recommended dose of the medication. Although participants reported considering a variety of factors when deciding between different OTC analgesics, there was no clear medication that was generally preferred. Our review was comprehensive; however, the quality of the studies was generally good to fair.

Adults frequently use oral OTC analgesics and possess a diverse set of beliefs about the efficacy and safety of the products. Pharmacists are well positioned to provide guidance to support the effective and safe use of these products.