Beware the hazards of over-the-counter (OTC) pain medications

A 30-year old male patient was recently admitted to my service via the emergency department. He came in complaining of abdominal pain and dark tarry stools. He mentioned a recent fall resulting in knee pain for which he had been taking 400 mg ibuprofen four times daily. He underwent upper GI endoscopy and was diagnosed with a bleeding gastric ulcer from his self-prescribed misuse/overuse of ibuprofen.

Fortunately, he recovered, but this case illustrates why we as providers need to be educating patients about the hazards of over-the-counter (OTC) pain medications. While physicians know the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) are we certain patients understand the potential risks?  Persons suffering everything from dental pain to muscle injury, menstrual cramps or headache are likely to treat themselves with ibuprofen or naproxen. But do they take the time to read the packaging information? While OTC warnings advise consulting a doctor for additional information, how often do patients actually come to the clinic with questions about their NSAID intake? The truth is these medications are not typically discussed unless a patient is admitted with a GI bleed or acute renal failure.

This case encouraged me to begin questioning my patients about their use of NSAIDs to find out if they were aware of the possible harm these drugs can cause. While most admitted using NSAIDs they gave different answers when it came to knowledge of side effects. Many patients were unaware of any complications. Others knew the medications should be taken with food, while some mentioned adverse effects such as liver toxicity. But the majority had no knowledge of the dangers of inappropriate doses of NSAIDs. I found this not only alarming, but something that needs correcting.

There are several things we can do to help protect our patients from the often serious side effects of NSAID use. Medical residents, in every specialty, need to know the importance of having a conversation with patients on the use and risks of OTC medications and they need to make this a routine practice. Pamphlets and written communication can also be helpful but need to be succinct and to-the-point. We as providers can also conduct an observational study asking our patients on their knowledge of proper NSAID use. Not only will this serve to advance health literacy on this important topic, it will improve overall health and, hopefully, can prevent the life-threatening complications.

Abeer Arain is an internal medicine resident.

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