One in Four Adults Use OTC Pain Relievers for Chronic Pain Management

In 2020, 1 in 4 adults in the United States (US) used pharmacologic treatments, such as over-the-counter (OTC) pain relievers for chronic pain management. These are the findings of a research letter published in the Annals of Internal Medicine.

The US Centers for Disease Control and Prevention (CDC) recommends that nonpharmacologic and nonopioid therapies be maximized for the treatment of chronic pain.

To evaluate how adults living in the US manage their chronic pain, researchers from the CDC sourced data for this study from the 2020 National Health Interview Survey (NHIS). Among the entire study cohort (N=31,568), the subset of adults (n=7422) who self-reported pain on most days or every day in the past 3 months were asked about use of pharmacologic and nonpharmacologic pain management therapies. Pharmacologic therapies were defined as prescription opioids, prescription nonopioids, and over-the-counter pain relievers. Nonpharmacologic therapies were defined as physical or occupational therapy (PT/OT), cognitive behavioral therapy (CBT), exercise, and complimentary therapies.

Among participants, the use of nonpharmacologic and pharmacologic therapies were:

• 60.2% used both nonpharmacologic and pharmacologic therapies,
• 26.6% used pharmacologic therapies only,
• 8.4% used nonpharmacological therapies only, and
• 4.8% used no pain management therapies.

The most common combinatorial approach was nonopioid medications plus any nonpharmacological therapy (50.9%).

The most common pharmacologic therapies were:

• over-the-counter medications (75.5%),
• nonopioid prescriptions (31.3%), and
• opioid prescriptions (13.5%).

The most common nonpharmacologic therapies were:

• exercise (55.0%),
• massage for pain (17.8%),
• physical therapy/occupational therapy (17.2%),
• meditation or other relaxation techniques (16.4%),
• spinal manipulation or other chiropractic care (11.4%),
• yoga, tai chi, or qigong (8.5%), and
• cognitive behavioral therapy (CBT) or other talk therapy (2.6%).

After adjusting for cofounders, individuals who were older, had public insurance, and had more severe pain were more likely to use opioids whereas younger individuals with higher household income, who lived in the Northeast, and were uninsured were less likely to use opioids.

Predictors for using nonpharmacologic therapies included higher household income, higher education, more severe pain, female gender, bisexuality, and living in the West.

This study may have included recall bias and may have been limited by not including data about treatment history or pain etiology.

“Among adults with chronic pain in 2020, over-the-counter pain relievers and exercise were the most prevalent pain management therapies, and prescription nonopioids were used more than twice as often as prescription opioids,” the researchers concluded. “Although most adults reported using both pharmacologic and nonpharmacologic therapies, approximately 1 in 4 adults reported using pharmacologic therapies only.”