Survey: Pain Sufferers Risking Overdose

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Many Americans who turn to over-the-counter (OTC) medicines for chronic pain, such as arthritis, migraines and backaches, are routinely ignoring medicine labels, according to physician and consumer surveys released by the American Gastroenterological Association (AGA). This practice puts people at risk of overdose which can lead to serious side effects such as stomach bleeding, ulcers, liver damage and even death.

“Pain is incredibly personal, but taking more than the recommended dose of OTC pain medicine doesn’t result in faster relief,” said Byron Cryer, MD, councillor-at-large, AGA Institute and associate dean, The University of Texas Southwestern Medical Center, Dallas. “Instead, it can cause significant stomach and intestinal damage, among other complications.”

The Gut Check: Know Your Medicine survey was conducted online by Harris Poll on behalf of AGA in September-October 2015 among 1,015 U.S. adults aged 30 and over (“consumers”) and 251 U.S. gastroenterologists. The survey was conducted with sponsorship support from McNeil Consumer Healthcare.

The survey found that, on average, a gastroenterologist sees nearly 90 such overdose cases every year, or about two patients a week, suffering complications caused by OTC pain medicines.

“We are not asking our patients to give up their OTC pain medicines,” said Anne M. Larson, MD, clinical professor of medicine at the Northwest Hospital/University of Washington Medicine Liver Clinic in Seattle. “Instead, we encourage safer, smarter use so they can get the relief they need to be comfortable and enjoy life.”

Gastroenterologists report that a vast majority of their patients who experience complications from OTC pain medicine overdose are trying to manage chronic pain or arthritis, and most are neglecting to consult physicians about OTC pain medicine. Moreover, most gastroenterologists report that patients are using OTC pain medicines at a higher dose and for a longer duration than recommended, or waiting too long to seek help for overdose symptoms.

AGA said these are particularly serious concerns because of the magnitude of the issue: According to The National Academies of Sciences, Engineering and Medicine 2011 report, Relieving Pain in America, chronic pain affects about 100 million American adults and costs the nation up to $635 billion annually, with those numbers increasing every year.

“It is a growing concern because people living with chronic pain and taking multiple medicines often don’t recognize the side-effects of taking too much,” explained Charles Melbern Wilcox, MD, professor of medicine in the division of gastroenterology and hepatology at the University of Alabama at Birmingham.

People Are in Pain

Forty-four percent of respondents report currently suffering from chronic pain, particularly in the back (27 percent) or knee(s) (17 percent). Most chronic pain sufferers (66 percent) have been experiencing pain for two years or more, though only about one in 10 (12 percent) have been diagnosed with chronic pain by a health-care professional.

Chronic Pain Sufferers Use Multiple Medicines to Treat Pain

The new research found that consumers who suffer from chronic pain are more likely to reach for the medicine cabinet (97 percent) than those who do not (81 percent). They are more likely to currently take or have taken prescription medicine (65 percent) or OTC medicine (93 percent) in the past 12 months.

Of those chronic pain sufferers who have taken OTC pain medicine in the past year, 79 percent are also simultaneously taking multi-symptom OTC medicine in the past year for allergies, cold, or flu symptoms — which greatly increases risk of negative side effects. “Taking multiple products with the same active ingredient can do more harm than good,” warned Dr. Cryer.

More than two in five (43 percent) chronic pain sufferers said they knowingly have taken more than the recommended dose at some point. Nearly three in 10 chronic pain sufferers (28 percent) have experienced complications due to OTC pain medicine overdose.

Gastroenterologists Are Concerned about Gut Complications

Nearly nine in 10 gastroenterologists (89 percent) believe that few patients connect the overdose symptoms they experience to the OTC pain medicines they are taking. Most gastroenterologists (85 percent) also say that patients are waiting too long to seek care when they start experiencing symptoms of an OTC pain medicine overdose.

“Many patients have exceeded the recommended dose for years without experiencing harm,” said Dr. Wilcox, “but it takes only one overdose for complications to occur and for that patient to end up in the hospital.”

When gastroenterologists see patients who have experienced complications due to OTC pain medicines, many report that the patients always/often tell them they wanted to feel better faster (73 percent) or their ability to get relief requires more than the recommended dose (45 percent). However, many consumers do not know that combining two or more nonsteroidal anti-inflammatory drug (NSAID, i.e., ibuprofen, naproxen sodium and aspirin) pain relievers (38 percent) or two or more acetaminophen products (38 percent) increases the risk of serious health complications.

Patients Need to Read Drug Labels

“We need to do more to educate patients about the need to read the drug label and to be cautious when taking medicines with the same active ingredient,” said Dr. Larson.

Nearly all (98 percent) gastroenterologists said it is important for consumers to recognize when other medicines they are taking (either OTC or prescription) share the same kind of active ingredient (acetaminophen or NSAID). Most chronic pain sufferers say they don’t always read the full Drug Facts label on an OTC pain medicine they haven’t taken before (66 percent) and many say the directions on the labels of OTC pain medicines are really just guidelines — they know what works for them (43 percent). More than one quarter of chronic pain sufferers (27 percent) are willing to take more of an OTC pain medicine than directed because they incorrectly believe their symptoms will disappear faster.

Education is Critical

The survey suggests the need for awareness and education is vital. More than half of chronic pain sufferers (54 percent) admit they could use better education on how to use OTC pain medicine safely. Nearly all gastroenterologists (95 percent) say that patients could avoid unnecessary hospitalizations by educating themselves on OTC pain medicine risks.

Americans living with chronic pain can get safe relief, but it is important to work with a health-care professional to effectively manage chronic pain. Chronic pain should never be self-managed with OTC medicines. AGA recommends:

  • Talk to your health-care professional about all the medicines you are taking.
  • Read and follow all medicine labels.
  • Only take one product at a time containing the same kind of ingredient.
  • Visit to learn more.

A national education campaign from AGA, Gut Check: Know Your Medicine, provides information and tips on ways to properly use common medicines that are most likely found in everyone’s medicine cabinet. AGA will launch an online challenge that leads users through an interactive Gut Check journey during which they must put their OTC pain medicine knowledge to the test in a fun and engaging way. You can soon take the challenge at

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Survey Method

The Gut Check: Know Your Medicine Survey was conducted online by Harris Poll on behalf of the American Gastroenterological Association from Sept. 30 through Oct. 8, 2015, among 1,015 U.S. adults aged 30+ (“consumers”), including 479 who currently experience chronic pain (“chronic pain sufferers”), and 251 licensed gastroenterologists who are office- or clinic-based and see adult patients ages 18 years or older (“gastroenterologists”).

The American Gastroenterological Association conducted this survey with sponsorship support from McNeil Consumer Healthcare. For complete research method, including subgroup sample sizes and weighting variables, please contact Sarah Beth Cloar.

About the Campaign

Gut Check: Know Your Medicine is an educational campaign created by the American Gastroenterological Association to motivate and empower individuals to use pain medicines safely. Medicine labels help adults understand what — if any — medicines share ingredients that could be harmful when taken together. By knowing ingredients, dosing instructions and warnings, individuals can play an important role in protecting their and their family’s health. To learn more about this campaign, explore

The American Gastroenterological Association developed this education program with sponsorship support from McNeil Consumer Healthcare.

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization