Is there any individual in this modern era of rapid pharmaceutical progress, who has never taken a self-prescribed painkiller?
Whether it is stress from workloads or upcoming exams, headache is a free takeaway. Whether it is the backache of a person living a sedentary lifestyle or any sort of musculoskeletal pain, all of a sudden, everyone becomes an expert physician and takes painkillers without consulting anyone.
An alarming fact, the self-claimed physicians are not even content with a single dose of paracetamol these days thanks to its dwindling efficacy. Consequently, they have switched to other NSAIDs, or nonsteroidal anti-inflammatory drugs like tolfenamic acid, indomethacin, diclofenac, ibuprofen, naproxen, aspirin (generic names), and many more both OTC (over the counter) and non-OTC painkillers without a minimum bit of hesitation.
In the present circumstances, it is a habitual phenomenon of a Bangladeshi to take a self-prescribed NSAID as an oral analgesic, or pain reliever expecting to get rid of a headache, backache, toothache, period cramps, muscle pain, fever, sore throat, abdominal cramps, pain due to minor wounds and what not!
Although they do not have a precise idea of the underlying pathology causing the pain, they are reluctant to consult with a registered physician. Moreover, amid this Covid-19, the consultation process has become far more inconvenient and it can be proposed that the self-prescribed consumption of painkillers is on the rise.
A recent study across the seven divisions of Bangladesh showed that more than 80% of Bangladeshis visit untrained village doctors (quacks) and drug retailers for primary consultation which is the prime factor in the rise of NSAID misuse.
Through rapidly growing mass media, people are aware of the tendencies to get addicted to analgesics like morphine or pethidine but they do not have a shred of cognisance about the potential risks of taking long-term NSAIDs.
According to a survey conducted in Dhaka South City Corporation, over 75% of the population purchase drugs from drug-stores without any authorised prescriptions, and about 34% of them purchased NSAIDs which was the highest-ranked among all other drugs.
Despite the frequency of NSAID adverse outcome occurrences, the majority of individuals seem quite healthy from the outside as most of the NSAID overdoses are asymptomatic or produce only minor symptoms, such as nausea, vomiting, or stomach discomfort during the early stage.
However, over time, they damage the internal organs severely and precipitate kidney complications, liver complications, bleeding disorders, allergic reaction, peptic ulcer disease, and teratogenic effects (abnormal fetal development when a pregnant woman consumes).
Even though Helicobacter pylori (a bacteria of the gut) is considered as the prime suspect for peptic ulcer disease (PUD), improvement of personal hygiene practice has reduced the occurrence.
However, recent data from western countries indicates that cases of NSAID-dependent PUD are increasing drastically. As the likelihood of ingesting NSAIDs or inadvertently taking another NSAID is increasing day by day. Gradually, NSAIDs will take up the top place as a risk factor of PUD in Bangladesh too.
NSAIDs act as a two-edged sword by potentially harming internal organs like the kidney, liver, gastrointestinal tract, cardiovascular system, nervous system, and by putting a halt in exploring the underlying pathology.
As a consequence, patients remain uninformed of the genuine cause of the pain. Eventually, the disease flares up and leaves no options for the physicians to cure and restore normal physiology.
Experts have confirmed that an alarming number of patients, even the young patients admitted to hospitals with chronic kidney disease, had a previous drug history of long-term and irrational use of NSAIDs. They get admitted with such a severe condition that only life-long dialysis and kidney transplantation could have given them a second chance to live, which is not affordable for all.
However, NSAIDs indicate patients with a severe rheumatic disease like osteoarthritis, rheumatoid arthritis, etc., or patients with severe migraines have no option left but to take NSAIDs as a prescribed medicine often. Does that mean they have to suffer from all the adverse effects aforementioned? No, not at all.
There is a term called "rational use of drugs'' which means patients will receive medications appropriate to their clinical needs, in doses that meet their requirements for an adequate period and at the lowest cost to them and their community.
Only an expert physician with explicit and interconnected knowledge of medicine can prescribe a drug rationally. Not to mention that the health care providers should be vigilant and pay heed to the specific history of a specific patient and carefully review the side effect profile of each NSAID while prescribing for long-term use. Thus, the risks and benefits of a drug for a particular patient can be balanced.
Even, the commonly accepted paracetamol is not a safe drug if it is used arbitrarily. Long-term consumption and overdoses can result in disastrous consequences.
Imposing a restriction on the trade of non-prescribed non-OTC NSAIDs and mass awareness regarding the use of NSAIDs can mitigate the prevalence of NSAID misuse substantially.
Rather than wandering on the internet or paying heed to the irrational counselling of anyone, why not try to track down the actual reason behind the pain by consulting with an expert? The key to open the door to salvation or the door to a black hole is your own choice.
Senjuti Seemanta is an MBBS (fifth-year) student of M Abdur Rahim Medical College, Dinajpur. She currently works as an intern at Biomedical Research Foundation.