INTRODUCTION:

Self-medication is well known among a wide range of population and it involves especially pain medications such as Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Self-medication is defined as the use and selection of medicinal products, including traditional and herbal products by individuals to treat self-recognized symptoms or illness, or continued use of a medication prescribed by a physician for or recurring diseases or chronic symptoms¹. The consumption of non-steroidal anti-inflammatory drugs (NSAIDs) is increasing among individuals from different age groups and this can lead to some complications and issues on the short-term as well as on the long-term^2-4. Appropriate self-medication for minor issues might be a common practice especially among students who find it more practical and affordable than taking an appointment with a physician. On the other hand, if it has been practiced inappropriately or excessively this can subject the individuals especially the young ones to the risk of complications and can have many consequences related to the environment as well as they do not decompose and hence, contaminate water supplies^3,4. Several factors including depression among adolescents can be experienced at this phase of their life due to many factors that can trigger low mood state and it could be transitory or chronic^5,4. It has been commonly known that pain caused due to several reasons is the well-known factor that leads to the consumption of pain medications and therefore several medication classes are used commonly such as paracetamol and NSAIDs to sooth the pain or the inflammation⁵. Given the large burden of human suffering that occurs when pain and psychological illness coincide due to many contributing factors, past thinking has been based in the outdated distinction between medically explained pain and psychogenic pain^6,7. If the use of these medications is not well monitored especially among adolescents with a lot of mood swings this might lead in some situations to serious behaviors such as suicide especially by using these affordable pain medications^7,8. A quantitative restriction should be adapted in order to prevent the suicide attempts brought about through their misuse⁹. The aim of our study is to assess the correlation between several types of pain and self-medication pattern of Paracetamol and NSAIDs among university students in United Arab Emirates (UAE).

MATERIAL AND METHODS:

This was a cross-sectional study that was conducted among university students across UAE aged 17 years and above from different nationalities and specialties. The respondents were assessed through a validated, self-administrated bilingual questionnaire that was used as a tool to collect data from the participants matching with the specified inclusion criteria. The study targeted 345 university students from the period of June 2018 until July 2018. The data were collected by hard copy and online questionnaire and it was analyzed using SPSS version 20.

Inclusion and exclusion criteria:

University students willing to participate and are able to understand English or Arabic from any age group with or without diseases were enrolled in the current study. The respondents must be a resident of United Arab Emirates. Language barrier, graduated participants, non-residents, and participants outside UAE were not enrolled in this study.

Pre-testing and validation of the questionnaire:

This questionnaire underwent testing by experts in the subject regarding relevance, design, and content. Several academics and researchers from Ajman University commented on the questionnaire for relevance of content and this led to some modifications in the questionnaire following their remarks. The validity of the questionnaire was further assessed in a pilot study in which 50 participants were involved.

Ethical considerations:

Prior to the administration of the questionnaires, the intentions of the questionnaire were explained in details and participants were encouraged to participate without any undue pressure. Participation was voluntary and all respondents joined in with no incentives and signed the informed consents to take part of this study. The research assured that anonymity would be maintained and ethical principles would be followed. The participant’s personal information will be kept in a closed closet for a certain period with full privacy.

Statistical analysis:

The data were coded and analyzed using the Product and Service Solutions, initially known as Statistical Package for the Social Sciences (SPSS) version 20. Descriptive statistics were used to summarize the data concerning the demographic characteristics. Categorical variables (such as Age groups and nationality) were described by using frequency, percentages and pie chart. A correlation was formed between the intake of certain pain medications and the reported types of pain for which respondents took pain medications for and the two tailed correlation was considered significant at the 0.05 level (2-tailed).

RESULTS:

The results show that the majority of participants (71.3%) were aged (18-21) and the majority were females (90.4%) followed by (9.6%) males. The majority of participants were from medical colleges (70.4%) while (29.6%) were from non-medical colleges and most of participants were senior last year students (34.2%) (Table1).

Table 1: Socio-demographic characteristics of participants

Variable	Frequency (n=345)	(%)
Age
17-18	13	3.80%
18 -21	246	71.30%
22 – 25	72	20.80%
26 – 29	12	3.50%
30 and above	2	0.60%
Gender
Female	312	90.40%
Male	33	9.60%
Nationality
Arab	339	98.30%
Other	6	1.70%
Medical College	243	70.40%
Pharmacy and Health Sciences	162	46.90%
Dentistry	81	23.50%
Non-Medical	102	29.60%
Engineering	54	15.50%
IT	9	2.60%
Business	16	4.60%
Education	5	1.40%
Law	9	2.60%
Media	9	2.60%
Study Year
First	40	11.60%
Second	73	21.20%
Third	114	33%
Last year (Senior)	118	34.20%

The results show that the majority of participants had some health issues (87%) and the most commonly reported health issues were Asthma (4.1%) followed by diabetes, hypertension, and peptic ulcer (1.4%, 0.9% and 0.9% respectively) (Table2).

Table 2: Health issues reported by respondents

Variable	Frequency (n=345)	(%)
Do you have health issues?
Yes	300	87%
No	45	13%
Reported health issues
Diabetes	5	1.40%
Hypertension	3	0.90%
Asthma	14	4.10%
High Cholesterol	2	0.60%
Peptic Ulcer	3	0.90%
Other	23	6.70%
Allergy	5	1.50%
Anemia	1	0.29%
Back pain	1	0.29%
Epilepsy	1	0.29%
Chronic Constipation	1	0.29%
Chronic Migraine	2	0.58%
Hypotension	1	0.29%
Carpal Tunnel	1	0.29%
Glucose 6 Phosphate Deficiency(G6PD)	1	0.29%
Hemophilia	1	0.29%
Hypothyroidism	2	0.58%
Irritable Bowel Syndrome (IBS)	4	1.17%
Mild Polycystic Ovary	1	0.29%
Vitamin D deficiency	1	0.29%

The results show that the majority of participants (26.4%) reported that they had experienced pain at least one day a week and the most frequently reported pain for which they take pain medications was headache (67%) followed by menstrual pain and abdominal pain (48.4% and 22% respectively). The most commonly used pain medication was Paracetamol (80.9%) and from the NSAIDs Ibuprofen was the most commonly used one (35.4%) followed by Mefenamic acid and Diclofenac (17.1% and 13.6% respectively) (Table3).

Table 3: Frequency of pain and consumption pattern of pain medications

Variable	Frequency (n=345)	(%)
How frequently do you suffer from pain or headache?
Almost never	61	17.70%
At least one day weekly	91	26.40%
About once a month	72	20.90%
Almost every day	35	10.10%
Several times a month, but not every week	86	24.90%
For which pain do you mostly take pain medications?
Headache	231	67%
Back pain	46	13.34%
Muscles and joint pain	42	12.20%
Toothache	60	17.40%
Abdominal pain	76	22.00%
Fever	67	19.40%
Menstrual Cramps (Period Pain)	167	48.40%
Trauma	4	1.20%
Other	16	4.60%
Which drug do you usually take by yourself for pain?
I do not use drugs usually	27	7.80%
Paracetamol	279	80.90%
Aspirin	15	4.30%
Ibuprofen	122	35.40%
Mefenamic acid	59	17.10%
Diclofenac	47	13.60%
Celecoxib	2	0.60%
Others	15	4.30%
Buscopan	2	0.57%
Cataflam	1	0.27%
Muscadol	2	0.57%
Herbal	3	0.86%
Iced/Warm compress	1	0.27%
Roxonin/Loflam	1	0.27%
Sleep	5	1.43%
Have you ever used more than one pain medication at the same time?
Yes	98	28.40%
No	222	64.35%
I do not know	25	7.25%

The results show that females who reported an experienced menstrual pain were significantly more likely to take Mefenamic acid and Ibuprofen to sooth the pain compared to other pain medications [p=0.000, OR: 5.223, 95% CI: 2.73 - 9.96; p=0.000, OR: 1.701, 95% CI: 1.263 - 2.29] respectively. There is no correlation was observed for Mefenamic acid usage and other types of pain. Another significant correlation was also observed among individuals who reported back pain as they were found to be more likely to use Aspirin [p=0.020, OR: 3.239, 95% CI: 1.159 - 9.05] and also Diclofenac [p= 0.000, OR:3.037, 95% CI:1.789 - 5.15] while no correlation was observed with other variables.

Individuals who experienced muscle pain were more likely to use Ibuprofen [p=0.005, OR: 1.676, 95% CI: 1.218 - 2.306] and Diclofenac [p=0.000, OR: 3.061, 95% CI: 1.792 - 5.228] while no correlation was observed with other variables. None of individuals who experienced either menstrual pain or back pain were more likely to use paracetamol or celecoxib to sooth the pain and the results showed an insignificant correlation (Table 4).

The results show that individuals who reported a toothache were more likely to take Paracetamol, Aspirin, Ibuprofen and Diclofenac [p=0.002, OR: 1.220, 95% CI: 1.120 - 1.32; p=0.018, OR: 3.167, 95% CI: 1.171 - 8.56; p=0.004, OR:1.618, 95% CI=1.201 - 2.17; p=0.000, OR: 2.692, 95% CI: 1.591 - 4.55] respectively. Individuals who reported intake of pain medications for fever were more likely to use only paracetamol [p=0.044, OR:1.137, 95% CI: 1.027 - 1.259] while other pain medications were not found to be significantly used. Both Mefenamic acid and Celecoxib showed a negative correlation with toothache and fever (p>0.05) (Table5).

Table 4: Correlation between (menstrual pain, muscles pain, and back pain) and the use of several pain medications.

	Menstrual pain					Muscle’s pain
	No.	%	Sig.	OR	95% CI	No.	%	Sig.	OR	95% CI
Mefenamic acid	49	29.3	0.000	5.223	2.73 - 9.96	9	21.4	0.427	1.299	0.690 -2.443
Paracetamol	139	83.2	0.280	1.058	0.955 -1.17	35	83.3	0.665	1.035	0.894 -1.198
Aspirin	9	5.4	0.358	1.599	0.582 - 4.39	2	4.8	0.888	1.110	0.259 -4.747
Ibuprofen	75	44.9	0.000	1.701	1.263 - 2.29	23	54.8	0.005	1.676	1.218 - 2.306
Diclofenac	28	16.8	0.009	1.571	0.913 - 2.70	14	33.3	0.000	3.061	1.792 - 5.228
Celecoxib	-	-	-	-	-	1	2.4	0.101	7.214	0.460- 113.1

Table 4: Continue

	Back pain
	No.	%	Sig.	OR	95% CI
Mefenamic acid	9	19.6	00.64	1.166	0.616 - 2.20
Paracetamol	35	76.1	0.350	0.929	0.784 - 1.10
Aspirin	5	10.9	0.020	3.239	1.159 - 9.05
Ibuprofen	22	47.8	0.054	1.440	1.023 - 2.02
Diclofenac	15	32.6	0.000	3.037	1.789 - 5.15
Celecoxib	1	2.2	0.127	6.478	0.41 - 101.7

Correlation is significant at the 0.05 level (2-tailed). OR: Odds Ratio, CI: Confidence Interval

Table 5: Correlation between toothache and fever and the use of several pain medications.

	Toothache					Fever
	No.	%	Sig.	OR	95% CI	No.	%	Sig.	OR	95% CI
Mefenamic acid	12	20	00.51	1.213	0.686 - 2.140	12	17.9	0.845	1.059	0.596 - 1.883
Paracetamol	57	95	0.002	1.220	1.120 - 1.320	60	89.6	0.044	1.137	1.027 - 1.259
Aspirin	6	10	0.018	3.167	1.171 - 8.560	4	6	0.468	1.509	0.496 - 4.591
Ibuprofen	31	51.7	0.004	1.618	1.201 - 2.170	29	43.3	0.131	1.294	0.939 - 1.782
Diclofenac	17	28.3	0.000	2.692	1.591 - 4.550	12	17.9	0.254	1.423	0.782 - 2.289
Celecoxib	1	1.7	0.222	4.750	0.301 - 74.80	1	1.5	0.274	4.149	0.263 - 65.48

Correlation is significant at the 0.05 level (2-tailed). OR: Odds Ratio, CI: Confidence Interval

DISCUSSION:

Pain medications such as Paracetamol and members of the NSAIDs family are usually used to provide an analgesic effect and can be used as adjunct treatments for several diseases such as back pain and arthritis and other serious conditions^10,11.

However, their known painkilling and anti-inflammatory effects ensure that they are often used and repeatedly overused without medical consultation, to relieve headache, menstrual cramps, cold and flu symptoms¹¹.

The current study showed that the majority of participants had some health issues (87%) and the most commonly reported health issues were Asthma (4.1%) followed by diabetes, hypertension, and peptic ulcer (1.4%, 0.9% and 0.9% respectively) (Table 2).

The results show that there was a significant correlation between the intake of mefenamic acid for pain and individuals that reported the use of pain medications for menstrual pain [p=0.000, OR: 5.223, 95% CI: 2.73 - 9.96] while no correlation was observed with other variables. Another significant correlation was also observed for the intake of Aspirin for back pain [p=0.020, OR: 3.239, 95% CI: 1.159 - 9.05] while no correlation was observed with other variables. Ibuprofen was found to be correlated for the use for both Menstrual pain and muscle pain [p=0.000, OR: 1.701, 95% CI: 1.263 - 2.29, p=0.005, OR: 1.676, 95% CI: 1.218 - 2.306 respectively] while no correlation was observed with other variables. Another significant correlation was also observed for the intake of Diclofenac for both muscles pain and back pain [p=0.000, OR: 3.061, 95% CI: 1.792 - 5.228; p=0.000, OR: 3.037, 95% CI: 1.789 - 5.15 respectively] while no correlation was observed with other variables. Paracetamol and Celecoxib showed a negative correlation with all the tested variables (Table 4).

The results show that a significant correlation was observed for the intake of Paracetamol for both toothache and fever [p=0.002, OR: 1.220, 95% CI: 1.120 - 1.32 and p=0.044, OR: 1.137, 95% CI: 1.027 - 1.259 respectively]. It was observed in our study that the majority of respondents (95%) reported using paracetamol for toothache

The following NSAIDs showed a significant correlation with the intake of pain medications for toothache, Aspirin [p=0.018, OR: 3.167, 95% CI: 1.171 - 8.56], Ibuprofen [p=0.004, OR: 1.618, 95% CI: 1.201 - 2.17] and Diclofenac [p=0.000, OR: 2.692, 95% CI: 1.591 - 4.55].

Only Paracetamol was found to have a significant correlation for the use during fever [p=0.044, OR: 1.137, 95% CI: 1.027 - 1.259] while other pain medications were found to have a negative correlation. Both Mefenamic acid and Celecoxib showed a negative correlation with all the tested variables (p>0.05) (Table 5).

Regarding the frequency of pain medications’ consumption, (20.9%) of our current study participants reported that they had experienced pain at least once a month, which is observed to be lower compared to another study conducted in Lahore, Pakistan which showed that (31%) used pain medications once a month. In contrast, our study result was higher compared to a study held in Malaysia showing only a (3.2%) consumption of pain medications once a month^12,13.

The majority of participants (26.4%) reported that they had experienced pain at least one day a week and the most frequently reported pain for which they take pain medications was headache (67%) followed by menstrual pain and abdominal pain (48.4% and 22% respectively) and similar results were observed in a previous study that revealed that headache represented (66.8%)¹⁴. It was also observed in a study held in Pakistan that (54%) of participants consumed analgesics for headache¹². In the current study, the most used pain medication was Paracetamol (80.9%) which is also was the most used one in a study held in in Lahore, Pakistan (46%)¹². In contrast to our results, another study held in Germany showed that ibuprofen was the most commonly used analgesic¹⁵.

From the NSAIDs, Ibuprofen was the most used one (35.4%) in our study followed by Mefenamic acid and Diclofenac (17.1% and 13.6% respectively). Similar results were observed in the same study that was done in Pakistan as the usage of Ibuprofen was similarly consumed as Mefenamic acid (13%) which is lower than our study results and Diclofenac (10%)¹².

Our study results revealed that Ibuprofen was consumed by (35.4%) of the respondents which was higher than a study held in Serbia in which the consumption was (25.803%) and higher than in Croatia (24.259%)¹⁶. In contrast, our results were lower than the results obtained from a study held in Denmark (42.720%)¹⁶.

Our study results revealed that Diclofenac was consumed by (13.6%) of the respondents which is lower than a study conducted in Serbia in which diclofenac was consumed by (50 %)¹⁶.

In the current study Aspirin was consumed by only (4.3%) of the respondents which is lower than a study held in UAE in 2010 in which (71.26 %) of respondents consumed Aspirin¹⁷.

CONCLUSION:

The majority of respondents used pain medications mainly to relief headache and the most frequently used pain medication was Paracetamol and from the NSAIDs, Ibuprofen was the most commonly used one. A significant correlation was observed between the intake of mefenamic acid and Ibuprofen for menstrual pain, Aspirin and Diclofenac for back pain, Ibuprofen and Diclofenac for muscle pain. Only Paracetamol was found to have a significant correlation for the usage during fever while other pain medications were found to have an insignificant correlation. The majority of individuals used only a single pain medication at a time and avoided combinations of pain medications.

LIMITATIONS:

The current study involved self-reported results which can have some disadvantages like reporting bias in answering certain questions.

CONFLICT OF INTEREST:

None to declare.

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Received on 07.06.2020 Modified on 12.08.2020

Research J. Pharm. and Tech. 2021; 14(6):3393-3398.

DOI: 10.52711/0974-360X.2021.00590