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Background: Pain is one of the symptoms for which any man is willing not only to go to the doctor but also to resort to any means, including self-medication, to "get rid" of it. Self-medication is not only a current practice but also a public health problem, under the circumstances that it can influence the way in which a disease is diagnosed and/or treated in a timely manner, and, consequently, repercussions may occur on the cost of treatment, in the case of severe forms. Pain is a vital symptom, and the diminution until the disappearance of pain is a fundamental right of each individual; the analysis of ethical issues in the case of self-administration of analgesic medication has not been a major concern., Areas of Uncertainty: Understanding the problem is important to realize whether self-medicating for pain is a necessity or an abuse, and in this respect, we review scientific articles from international databases: PubMed and ProQuest., Data Sources: The study is based on the consultation of scientific articles from international databases-PubMed and ProQuest, the main keywords in the search being pain and self-medication, to which a stigma or public health is sequentially added., Results: Pain is becoming more and more a global problem and the extent of its spread can substantiate our assertion about pathology with pandemic impact. Under the pressure of patient associations, of the media, and of nonmedical authorities, the opinion about the need for a stoic approach to pain has long become an outdated theory, and chronic pain, beyond a multidimensional approach, is increasingly considered not only a useless element but also even a destructive one., Conclusions: Pain and self-medication must be addressed, including in medical practice, starting from their multidimensionality from the following perspectives: medicobiological, sociocultural, instructive-educational, legal-political, and especially ethical. They are not only individual health problems but also become, when connected with a stigma, a public health problem.

Approximately 90% of pregnant women use medications while they are pregnant including both over-the-counter (OTC) and prescription medications. Some medications can pose a threat to the pregnant woman and fetus with 10% of all birth defects directly linked to medications taken during pregnancy. Many medications have documented safety for use during pregnancy, but research is limited due to ethical concerns of exposing the fetus to potential risks. Much of the information gleaned about safety in pregnancy is collected from registries, case studies and reports, animal studies, and outcomes management of pregnant women. Common OTC categories of readily accessible medications include antipyretics, analgesics, nonsteroidal anti-inflammatory drugs, nasal topicals, antihistamines, decongestants, expectorants, antacids, antidiarrheal, and topical dermatological medications. We review the safety categories for medications related to pregnancy and provide an overview of OTC medications a pregnant woman may consider for management of common conditions.

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

Treatment nonadherence is a leading cause of poor outcomes among populations with bipolar disorder (BD) and is related to subjective experience of illness and treatment. This study examined gender differences in the experience of illness and treatment for those with BD, specifically in regards to treatment adherence. This cross-sectional analysis pooled data from 3 BD studies. A semistructured qualitative instrument, the Subjective Experience of Medication Interview, elicited information on subjective differences in treatment adherence between men and women. Men and women experience comparable levels of stigma and they comparably value lessened irritability and/or impulsivity because of medications. However, men and women differed in fear of weight gain because of medications, value of social support, and self-medication behaviors. Selected differences in subjective illness experience between men and women might be used to inform gender-sensitive approaches to enhance treatment adherence among populations with BD.

Self-medication is a common behavior among individuals with anxiety disorders, yet few studies have examined the correlates of this behavior. The current study addresses this issue by exploring the pattern of mental health service use and quality of life among people who self-medicate for anxiety. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions and was limited to the subsample of individuals meeting criteria for an anxiety disorder in the past 12 months (n = 4880). Multiple regression analyses compared 3 groups-(1) no self-medication, (2) self-medication with alcohol, and (3) self-medication with drugs, on mental health service use and quality of life. After adjusting for potentially confounding covariates, individuals who engaged in self-medication had significantly higher service use compared with people with anxiety disorders who did not self-medicate (adjusted odds ratio = 1.41, 95% CI = 1.06-1.89). Self-medication was also associated with a lower mental health-related quality of life compared with those who did not self-medicate. Clinicians should recognize and respond to the unique needs of this particular subpopulation of individuals with anxiety disorders.

Purpose of Review: To explore why epinephrine autoinjectors have failed to prevent fatal food anaphylaxis and how this problem might be solved., Recent Findings: Autoinjectors cannot save lives when they are used too late, misused, not carried, or when an inadequate dose is absorbed; food allergy-induced asthma may not respond when asthma management is suboptimal. New markers for severe reactions have been published., Summary: The fallibility of autoinjectors means that in the management of food allergy, their provision must take second place to accurate identification of the trigger foods, optimal avoidance, and optimal treatment of other medical conditions that make reactions more dangerous.

This study examined the prevalence and correlates of self-medication of anxiety disorders with alcohol and drugs in a nationally representative sample (N = 5877). A modified version of the Composite International Diagnostic Interview was used to make DSM-III-R mental disorder diagnoses. Frequencies of self-medication ranged from 7.9% (social phobia, speaking subtype) to 35.6% (generalized anxiety disorder). Among respondents with an anxiety disorder, self-medication was significantly associated with an increased likelihood of comorbid mood disorders, substance use disorders, distress, suicidal ideation, and suicide attempts. Self-medication behavior remained significantly associated with an increased likelihood of suicidal ideation (adjusted odds ratio = 1.66; 1.17-2.36) as well as suicide attempts (adjusted odds ratio = 2.23; 1.50-3.31), even after adjusting for a number of sociodemographic and psychiatric variables. These results suggest that individuals with anxiety disorders who self-medicate their symptoms with alcohol or drugs may be at increased risk for mood and substance use disorders and suicidal behavior.

Worldwide, there has been an emerging patient demand for access to efficient drugs without consulting a doctor and obtaining a prescription. As a result, there has been an expanding movement of prescription-only drugs to over-the-counter (OTC) status. An increasing number of drugs are becoming available OTC, empowering patients to treat themselves. Where the principle of empowering individuals to treat themselves can fail is when consumers lack the knowledge to do so safely. This potentially applies to the self-selection of analgesic drugs by consumers. When used inappropriately, these drugs pose significant risks. The nonsteroidal antiinflammatory drugs (NSAIDs) are associated with many adverse reactions, interactions, and contraindications in a number of patient groups, even at OTC doses. In particular, in the elderly, the high incidence of cardiovascular and gastrointestinal disease, coupled with age-related decline in renal function and multiple medication use, all warrant extra caution with the use of NSAIDs and make paracetamol the simple analgesic drug of first choice. Despite the possibility of hepatotoxicity in overdose, paracetamol represents a better all-round option for most patients requiring OTC analgesic therapy.

Although Americans are increasingly using herbal products for a variety of health conditions, they may not be aware of the demonstrated risks and benefits of these products. This study found public knowledge of 5 commonly used herbal products to be quite low, even among users of the investigated herbs.

Responsible self-medication provides a positive health outcome for the individual and benefits for society as a whole. Nonprescription analgesics are among the most widely used drugs for self-medication, playing a key role in the management of a number of common disorders. While ensuring that the benefits of self-medication are available to consumers and to society, it is important to acknowledge the potential risks inherent in the widespread and unsupervised use of medicines. Along with drugs that are well tolerated and effective in normal use, responsible self-medication depends on providing consumers with the information they need to use drugs appropriately in a proven usable form, and it can benefit from the advice and guidance offered by health care professionals.

Knowledge and self-efficacy concerning interactions of antihypertensives with over-the-counter (OTC) analgesics and alcohol were assessed in 51 adults aged 60 and older taking antihypertensives and attending a blood pressure clinic. The subjects had low self-efficacy about how to prevent interactions of antihypertensives with OTC analgesics and alcohol. Inspection of knowledge item responses revealed eight general misconceptions about OTC medications. These data guide educating those with hypertension about potential drug interactions arising from self-medication.

Objectives: Releasing prescription drugs over-the-counter (OTC) has been a trend in many Western countries. The purpose of this study was to find out about Finnish physicians' attitudes towards OTC switches and to find out whether transfer of drugs that are used in a doctor's own area of specialty increases negative attitudes toward release. For the latter purpose, gynecologists' perceptions about the availability of vaginal antifungal OTC drugs was studied., Methods: Postal questionnaire to a representative random sample of gynecologists (n = 169) and general practitioners (GPs) (n = 288) in six counties in Finland in 1996. After a reminder, the response rate was 77% (n = 341). Multivariate logistic regression models were used to explore the relationship of factors to attitudes toward OTC drugs., Results: The overall attitude toward the availability of OTC drugs was moderately positive but was more reserved toward those drugs only recently given OTC status. However, physicians were judged in many cases to be the most suitable source of information on OTC drugs. GPs working in health centers, more often than other physicians, found drugs suitable for self medication. Our hypothesis about gynecologists being against the release of vaginal antifungal drugs was not supported., Conclusions: Physicians' views about OTC drugs are influenced by the current OTC status of the drug and by public discussion. The place of work has an important influence on these opinions, most likely reflecting the effect of case mix and patient load.

Alcohol and other drugs of abuse are commonly used by persons with schizophrenia and contribute to the overall morbidity of the disorder. Standard, or typical, antipsychotic drugs do not limit such substance use and may even render it more likely. However, preliminary data from our group and others suggest that the atypical antipsychotic clozapine may decrease substance use in this population. While recognizing the likelihood that substance use decreases negative symptoms (as well as extrapyramidal symptoms) in persons with schizophrenia, we hypothesize that the biological basis of substance use relates to a "reward-deficiency syndrome" secondary to dysfunctional dopamine-mediated mesocorticolimbic neurons in these individuals. We further suggest that clozapine's beneficial effect in patients with comorbid schizophrenia and substance use disorders may relate to its presumed ability to ameliorate the deficits in both the mesocortical and mesolimbic dopaminergic neuronal projections through its various actions on dopaminergic, serotonergic, and particularly noradrenergic neurons.

Comorbid substance use disorders occur frequently in schizophrenia with significant detrimental effects to clinical outcome. Unfortunately, attempts to identify factors associated with comorbid substance use disorders (beyond demographic characteristics such as gender) have not been successful. This study examined an affect regulation model of comorbid substance use in schizophrenia with a focus on personality traits and coping. It was hypothesized that maladaptive coping and the traits of negative affect (NA) and disinhibition (DIS), but not trait positive affect (PA), would be associated with greater substance use problems. Thirty-nine patients with schizophrenia or schizoaffective disorder completed measures of personality traits, coping, and negative consequences associated with substance use. Traits were differentially associated with coping in that NA and DIS, but not PA, were associated with maladaptive coping including the use of drugs and alcohol to cope with stress. Alternatively, PA, but not DIS or NA, was related to adaptive coping strategies. Individuals high in NA and endorsing the use of drugs and alcohol to cope reported the greatest number of negative consequences from substance use. This finding held after controlling for gender. These results are consistent with an affect regulation model of substance use and suggest the advantage of examining the role of affect, traits, and coping in understanding comorbid substance use in schizophrenia.

Opiate-dependent patients (N = 231), classified by sedative disorder status, were characterized according to DSM-IIIR on substance use and psychiatric disorders. Twenty-one percent currently (CUR+) had sedative use disorder, 39% had a history (HX+) of sedative use disorder, and 40% had no history (HX-) of this disorder. Several group differences were found. The HX+ and CUR+ groups had more lifetime drug use disorders (means = 4.5 and 4.3 vs. 3.2 in the HX- group), including alcohol, cannabis, stimulants, cocaine, and hallucinogens. In contrast, other psychiatric disorders (e.g., anxiety and depression) were low in prevalence and did not differ across groups, with the exception of a higher prevalence of antisocial personality disorder in the HX+ and CUR+ groups (39.6% and 38.5% vs. 17.9% in HX- group). The results suggest that sedative use disorder is related more to a severe spectrum of multiple substance abuse than it is to self-medication of underlying mood or anxiety disorders.

Although studies of illness behavior have concentrated on utilization of formal services, recent research has highlighted the importance of lay care. In this article, patterns of self-treatment of symptoms among a sample of older people living in community settings are explored. Data were collected through personal interviews and health diaries completed by a probability sample of 667 elderly people. A majority of respondents managed most symptoms on their own. A decision to take no action was a common response to a number of symptoms. Prescription and over-the-counter medications were the most frequently reported intervention strategies. Multivariate analyses affirmed the importance of both symptom interpretation and symptom experience on lay treatment decisions. Causal attributions and prior experience with symptoms exhibited a less consistent impact on lay care strategies. Whether people ignore or treat symptoms appears to have less to do with their familiarity and causal explanation than with whether or not the symptom causes them pain or discomfort, whether it interferes with their desired activities, or whether they think it might be indicative of a serious decision.

We reviewed studies measuring unsupervised use of psychoactive substances in schizophrenic and control populations and organized the results by substance class. Despite much variation in their methodologies, these studies broadly agreed that schizophrenic groups' use of amphetamines and cocaine, cannabis, hallucinogens, inhalants, caffeine, and tobacco was significantly greater than or equal to use by control groups consisting of other psychiatric patients or normal subjects. Schizophrenic groups' use of alcohol, opiates, and sedative-hypnotics was significantly less than or equal to use by control groups. We discuss the implications of this nonrandom pattern of drug choice for the hypothesis of substance abuse as a form of self-medication in schizophrenia.