Pain, Youth and Over-the-Counter Analgesics (SUS)

This project aims to examine pain and the use of Over-The-Counter (OTC) analgesics among adolescents.

The project will investigate the prevalence of, and factors and conditions associated with use of such pain medicines.

Further it seeks to develop strategies to promote responsible use of OTC analgesics.

Among Norwegian youths, approximately 20 percent use OTC analgesics frequently. Many of these adolescents struggle with persistent pain, stress, anxiety and depression, school absence and reduced health related quality of life.

Their health-related problems increase during adolescence and often manifests in adulthood.

  • Participants

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  • More about the project

    Frequent pain among children and other young people has been identified as a common and increasingly important problem for young people, their families and society. Pain is a complex phenomenon with many different causal explanations that can impact young people's quality of life negatively.

    Psychosocial conditions such as stress, anxiety, depressive symptoms, and traumatic experiences are associated with an increase in adolescent pain and their use of pain medication.

    In Norway, as in most countries, OTC analgesics are legally available without a prescription or advice from a healthcare professional. From the age of 16, OTC analgesics can be bought at pharmacies, supermarkets, and petrol stations.

    High consumption of OTC analgesics can be a way for young people to cope with mental and social challenges.

    Improper, excessive, or regular use of pain medicine is linked to several negative side effects, such as medical overuse headaches, gastrointestinal problems and serious and serious irreversible kidney and liver damage.

    Parents' attitudes towards use of pain medicine influence their children’s use and most adolescents have access to OTC analgesics at home. However, self-administration with OTC analgesics often starts early in adolescence, already at the age of ten.

    Although most young people have a responsible attitude towards use of OTC analgesics, some have a more irresponsible attitude, occasionally associated with a lack of knowledge about such drugs. Nevertheless, young people themselves assessing their knowledge as satisfactory.

    Continuous use of project results

    The project has been ongoing since 2009 and comprises several sub-projects that have shed light on young people's experiences with pain and use of OTC analgesics.

    Results from the project are being used continuously to spread knowledge about responsible use of pain medicines among adolescents, parents, teachers, and health professionals.

    To raise the knowledge and attention of especially doctors, nurses, pharmacy staff and health professionals the project managers collaborate with health authorities on campaigns, e-learning programmes, webinars and conveyance on conferences.

    Such knowledge also has impacted directly how authorities develop learning programmes and information campaigns on the topic.

    The studies have been conducted through close collaboration between researchers at OsloMet, the University of Oslo (UiO) and the University of Agder (UiA).

    Unanswered research questions

    Many issues have been answered during the project period, but many unanswered research questions remain.

    Among these, it appears that OTCA overdoses have increased significantly among young people, which emergency department personnel have known for the past few years, but health authorities have not systematically examined the trend, which also remains underexamined in the literature.

    International studies indicate that during the COVID-19 pandemic, the number of young people admitted to hospitals for paracetamol overdoses tied to self-harm increased.

    Furthermore, OTCA sales have surged sharply, indicating the likelihood of greater access and higher consumption among children and other young people, along with a potentially greater risk of overdoses.

    OTCAs are easily available, and they are advertised in mass media, which also can contribute to higher consumption.

    We know little about the long-term consequences of adolescents’ frequent OTCA use over time.

    Some international studies indicate that high consumption can lead to lasting negative health effects, but we do not have sufficient knowledge about what the limit values are in relation to intake/age and duration of use.

    The project consists of several sub-studies.

    • SUS 1

      SUS 1 was the first study in which young people's OTCA use was mapped in Norway.

      The study was developed in close collaboration with users, comprising young people, health personnel and school staff and including both qualitative and quantitative methods, as well as development of a questionnaire to map OTCA use.

      The study was conducted in collaboration between the University of Oslo, RELIS (National network of four regional medicines information and pharmacovigilance centres in Norway) and the Faculty of Health Sciences (HV) at OsloMet.

    • Norwegian KIDSCREEN study

      A PhD project that investigated health-related quality of life and pain in children and adolescents ages 8–18.

      The project was conducted in collaboration with the University of Bergen and the European KIDSCREEN group and ended in 2011.

    • SUS 2

      A PhD project, "Frequent use of OTCAs among adolescents – a warning sign of troubled lives".

      The dissertation included three studies on young people’s painkiller use related to

      • the extent of use and factors related to high consumption
      • connections between frequent OTCA use and development of identity
      • risk of reduced quality of life

      The project ended in 2018.

    • SUS 3

      Further studies that have investigated the connection between adolescents’ use of OTCAs and

      • parents' attitudes and adolescents’ use of OTCAs
      • mothers' experiences with their own health
      • the importance of social exclusion and bullying
      • psychological health challenges in the form of anxiety and depression symptoms
    • SUS 4

      A new PhD project that goes deeper into the topics related to the use of nonprescription painkillers and mental health problems.

      In November 2023, an article was submitted that offers extended insight into connections between high consumption of nonprescription painkillers and various symptoms of mental health problems.

    • iCanCope with PainTM, Norway

      A PhD project in which the purpose of the thesis was to adapt and examine culturally the use of an app for pain management, as well as examine pain and quality of life in young people with long-term pain in upper secondary school.

      The project was completed in 2021 and was a collaborative endeavour with the University of Agder and the University of Toronto. It was financed by the University of Agder.

    • StartYoung

      A longitudinal project in which the purpose is to generate new knowledge about quality of life and pain among adolescents and their parents, as well as investigate potential family and regional patterns.

      Another purpose is to study factors that can affect quality of life, pain and coping with pain, as well as investigate the relationship between adolescents and their parents' quality of life, pain experience and coping with pain.

      A PhD student completed their doctorate while working on the project. A collaborative project with the University of Agder. Financed by the University of Agder and OsloMet.

    • SUS 5 – Young-Youth

      This sub-study investigates factors that may be related to OTCA use among children during their transition to youths (10–12 years). Data from this age group indicate new and surprising findings.

      For example, consumption was higher than among young people ages 13 and up, young people with an immigrant background demonstrated significantly higher consumption than other young people and physical activity increased the risk of frequent OTCA use.

      The Young-Youth team has submitted one article (under review), and three others are being planned and prepared.

      SUS 5 is a collaborative project between OsloMet and the University of Agder.

  • Partner institutions

    • Akershus University Hospital
    • University of Agder
    • University of Oslo
    • University of Toronto and Sick Kids Hospital