USE OF PAIN MEDICINES IN THE REPUBLIC OF NORTH MACEDONIA (KNOWLEDGE, ATTITUDES AND PRACTICES)
Keywords:
analgesics, concerns, OTC, over the counter medicationsAbstract
Pain is a universal human experience and remains one of the most significant public health challenges worldwide because of its wide ranging physical, emotional, and social effects. It is one of the most common reasons people seek medical care and continues to be a leading cause of reduced daily functioning, lower productivity, and a diminished quality of life. Despite its impact, most patients do not seek medical attention when experiencing pain but instead rely on self medication with over the counter (OTC) analgesics. These medicines can be effective when used responsibly; however, inappropriate use, excessive dosing, or combining multiple products without professional guidance can lead to serious health risks, including adverse reactions, masking of underlying diseases, medication interactions, or even long term complications. The growing availability of OTC pain medicines, together with limited public knowledge about their risks, has contributed to rising rates of self treatment both globally and in the Republic of North Macedonia. Modern lifestyle demands, the high prevalence of chronic pain, and increased trust in non prescription products further support this trend. Although OTC analgesics are widely perceived as safe, scientific evidence consistently shows that misuse may lead to gastrointestinal, cardiovascular, renal, hepatic, psychological, and dependency related complications. This underscores the need for better public education and reliable counseling from pharmacists and other healthcare professionals.
This paper examines the use of pain medicines in North Macedonia by exploring knowledge, attitudes, and practices related to self medication with OTC analgesics. It analyzes global and national trends in consumption, identifies key factors influencing increased use, and discusses potential risks associated with inadequate pain management. In addition, the study highlights the importance of proper patient education, regulatory control, and the role of healthcare providers in promoting rational and responsible use of analgesics. By presenting these insights, the paper aims to improve understanding among individuals who rely on OTC analgesics for self treatment and to encourage safer strategies for addressing pain at the population level.
References
Baker, C., & Johnson, M. (2024). Psychological impacts of living with chronic pain: A multidisciplinary approach. Global Health Psychology, 9 (2), 89-102.
Bessell, T. L., Emmerton, L., & Nissen, L. (2003). Use of online pharmacies by consumers. Journal of Clinical Pharmacy and Therapeutics, 28(3), 233–240.
Botea, M.(2020). Analgetics. In book: Pain Management. https://doi.org/10.5772/intechopen.94319
Builders, M.I. & Aguwa, C.N. (2012), Patients attitude towards analgesic usage in Nsukka community. Der PharmaciaLettre, 4, 641-648.
Centers for Disease Control and Prevention - CDCP. (2023). Addressing opioid misuse in chronic pain management. https://www.cdc.gov.
Cook, W.B. (2008). Common Adverse Events and Interactions with OTC Pain Medications. U.S. Pharmacist, 33(5), 44-56.
Diener, H-C., Holle, D., Dresler, T. & Gaul, C. (2018). Chronic headache due to overuse of analgesics and anti-migraine agents. Deutschers Ärzteblatt International, 115, 365–371.
Ehiguator, O., Azodo, C.C., Ehizele, A.O., Ezeja, E.B., Ehigiator, L. & Madukwe, I.U. (2013). Self-medication practices among dental, midwifery and nursing students. European Journal of General Dentistry, 2 (1), 54-57.
Goyal, M., Smith, T. W., & Jones, R. (2021). Managing chronic pain in a fast-paced world: Trends in analgesic use. Journal of Pain Management, 14 (3), 214-223.
Hall, K., Stewart, C., & Thomas, L. (2012). Patterns of over-the-counter drug use and misuse. Journal of Public Health Research, 1(1), 15–24.
Institute of Medicine – IM. (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US).
International Association for the Study of Pain (IASP). (2020). Chronic pain in the context of malignancy: Definitions and classifications.
Kamaldeen, A., Ahmed, R., & Bello, M. (2012). Evaluation of analgesics usage in pain management among physicians. Journal of Applied Pharmaceutical Science, 2(7), 194–198.
Le Grand, A., Hogerzeil, H. V., & Haaijer-Ruskamp, F. M. (1999). Intervention research in rational use of drugs: A review. Health Policy and Planning, 14(2), 89–102.
Ministry of Health of North Macedonia (2024). Rulebook on the manner of prescribing and dispensing of prescription drugs (Based on Article 13 paragraph 4 of the Law on Medicines and Medical Devices). Official Gazette of the Republic of Macedonia No. 106/07. Available at: https://fzo.org.mk/WBStorage/Files/Pravilnik%20za%20nacinot%20na%20propisuvanje%20i%20izdavanje%20na%20lekovi%20na%20recept.pdf
Mumtaz, Y., Jahangeer, S. M., Mujtaba, T., Zafar, S., & Adnan, S. (2011). Self-medication among university students of Karachi. Journal of Liaquat University of Medical & Health Sciences, 10 (3), 102-105.
National Library of Medicine (NLM). (2021). Painkillers: How common are severe side effects of NSAIDs? InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK361008/
Sarahroodi, S., Maleki-Jamshid, A., Sawalha, A. F., Mikaili, P., & Safaeian, L. (2012). Pattern of self-medication with analgesics among Iranian university students in central Iran. Journal of Family and Community Medicine, 19(2), 125–129.
Sesiuk, A., Kotlińska-Lemieszek, A., & Grądalski, T. (2023). Pain treatment and risk associated with the use of analgesics on admission to the internal medicine ward: A prospective observational study. Palliative Medicine Archives, 133(11), 1–9.
Smith, T., & Taylor, P. (2021). Branding and packaging effects on over-the-counter medication use. Pharmaceutical Research Journal, 9 (3), 145–157.
Smith, L., Taylor, P., & Brown, R. (2023). Understanding risks and benefits of over-the-counter medications. Journal of Pharmacological Safety, 15 (3), 105–112.
Statista. (2025a). Analgesics – Worldwide. https://www.statista.com/outlook/hmo/otc-pharmaceuticals/analgesics/worldwide
Statista. (2025b). Analgesics – North Macedonia. https://www.statista.com/outlook/hmo/otc-pharmaceuticals/analgesics/north-macedonia
The British Pain Society (2010). Understanding and managing pain: information for patients. London: The British Pain Society.
Watson, J. (2012). Pain mechanisms: A review. Australian Journal of Physiotherapy, 27, 191–198.
World Health Organization. (2010). Medicines: rational use of medicines. Geneva. Available at: http://www.who.int/mediacentre/factsheets/fs338/en/
World Health Organization. (2022a). Access to essential medicines: Addressing disparities. Available at: www.who.int
World Health Organization. (2022b). Chronic pain: The silent epidemic. Available at: www.who.int
