title: Association of health-related quality of life with dual use of prescription and over-the-counter nonsteroidal antiinflammatory drugs.
abstract: OBJECTIVE
  Inadequate prescription therapy pain management, lack of doctor-patient communication about over-the-counter (OTC) medications, and easy accessibility of OTC medications may contribute to patients using more than 1 medication to manage pain. It is well established that taking multiple nonsteroidal antiinflammatory drugs (NSAIDs) can lead to serious gastrointestinal problems. Little is known about whether use of more than 1 NSAID (i.e., dual use) is related to patient self-reported outcomes, specifically health-related quality of life (HRQOL). We hypothesized that dual use of NSAIDs would be associated with reduced HRQOL.
  
  
  METHODS
  Patients from a managed care organization who filled > or =1 NSAID prescription over a 6-month period were eligible for a telephone interview focusing on NSAID use, which included the Short Form 12 (SF-12) Health Survey. Dual use was defined as taking 2 NSAIDs, either prescription or OTC, at least twice weekly during the past month. A multivariable linear regression model examined the association between dual use and the Physical Component Summary score (PCS-12) from the SF-12.
  
  
  RESULTS
  Dual use was associated with lower PCS-12 scores indicating poorer HRQOL, after controlling for clinical and demographic factors.
  
  
  CONCLUSIONS
  Patients may self-manage their pain to improve their daily activities by taking more than 1 NSAID. However, by attempting to obtain symptom relief, patients may be putting themselves at risk for complications. Providers are likely unaware of patients' risk. Future research should evaluate the causal factors contributing to dual use.
authors.affiliation: Durham VA Medical Center, Durham, North Carolina 27705, USA. stacey.kovac@duke.edu
authors.forename: Stacey H
authors.initials: SH
authors.lastname: Kovac
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000188:drug therapy* / Q000523:psychology; D004366:Nonprescription Drugs / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000523:psychology; D011788:Quality of Life
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004366:Nonprescription Drugs