COMMENTARY

Over-the-Counter Analgesia: It Matters Now More Than Ever

Charles P. Vega, MD

Disclosures

August 26, 2015

In This Article

The Medicine That Patients Don't Think Is Medicine

It has been another fairly exhausting clinic visit for Mrs Smith. I have covered six of her chief complaints and addressed three issues that I thought were critical in the management of her multiple chronic conditions. I wonder just how unprofessional it would be to suggest a 5-minute power nap for both of us, and then we can try again, refreshed.

Wishful thinking. I press on, examining each of the 15 prescription bottles placed carefully on the counter.

"Here's some good news. I see that you have refills on your medications. These are all of them, correct?"

"Yes, doctor."

But, wait—I can see into her purse now. "What about those bottles in there?"

"Oh, those aren't medicine. They're just some pills I use sometimes."

"May I please see them?"

"Of course, doctor."

Naproxen, ibuprofen, acetaminophen, ibuprofen/diphenhydramine, acetaminophen/hydrocodone. "Mrs Smith, how often do you use these pills?"

"You know, I'm not really that sure. I take some of them every day, but on a bad pain day, I might use all of them."

This case is sadly indicative of how my medication reconciliation is often completed: through serendipity. It feels ironic that in a patient with heart failure, chronic renal failure, and a history of stroke, the use of over-the-counter (OTC) analgesics might be one of the biggest risks to her health.

But it is true, and statistics demonstrate the impact of OTC analgesics: 30% of adults in the United States have experienced pain over 6 months in duration.[1] Meanwhile, nearly half of American adults have received a prescription medication in the past month, and about half of patients receiving prescription medications are also taking OTCs.[2,3] Analgesics are by far the most popular class of OTC medications

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