Study of patients' attitudes towards non-steroidal anti-inflammatory drugs

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Introduction
Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs that act in therapeutic doses as anti-inflammatory, antipyretic and analgesic agents. Their use is justified in the event of febrile, inflammatory and pain syndromes. One of the most important areas in therapeutic treatment is the rapid and effective relief of pain [2].
The ability of a drug to penetrate the skin into deeper tissues is influenced by a number of factors, including the structure of the molecule, dosage form, the site of application of the drug to the skin and the method of application [3]. Pain caused by diseases of the musculoskeletal system, nervous and cardiovascular systems, gastrointestinal tract organs often impairs the quality of life of patients, worsens their mental and physical condition, which leads to loss of ability to work. Patients need medical care, including a set of therapeutic measures to eliminate possible causes, pathogenesis and symptoms of the above diseases.
Local NSAIDs are intended for local analgesia by inhibiting cyclooxygenase (COX)-2, which gives a less pronounced systemic effect than with oral administration. In this case, the drug should penetrate the skin into deeper tissues and have a local effect. It is assumed that repeated local use of NSAIDs leads to the formation of a drug reservoir in the skin and subcutaneous fat tissue, resulting in controlled release in the surrounding tissue [3].

Based on literature data, modern concepts of the use of NSAIDs in therapeutic practice have been determined [4]:
1. The effectiveness of different NSAIDs is currently not the basis for choosing a particular drug in the treatment of an individual patient.
2. The features of the action of an individual NSAID are not the basis for choosing a drug for a specific nosological form.
3. The expected positive effects of NSAIDs in the vast majority of cases are considered as their symptomatic effect.
4. The main tool for assessing the effectiveness of NSAIDs in most studies is monitoring the dynamics of pain syndrome.
5. Achieving the expected positive effect from the use of NSAIDs is not a basis for adjusting the timing and/or regimens of treatment, while the absence of the expected positive effect from NSAIDs in the short term (up to 2 weeks) is a basis for adjusting treatment.
Most clinical guidelines emphasize that the effectiveness of NSAIDs is considered equal [4]. This became the basis for the postulate that there is no priority when choosing a drug from the NSAID group. According to current practice, the choice of an anti-inflammatory agent is based on an analysis of the safety of individual molecules. When several drugs have comparable safety, the economic aspect of use can be considered. However, there is a contradiction: the conclusion about the equal effectiveness of NSAIDs, obtained on the basis of group data, is not always applicable to the individual choice of drug.
It is clear from clinical guidelines that patients suffering from inflammatory diseases of the joints and spine are recommended to switch to another NSAID in the absence of a positive effect from the initial one [4]. This implies that different patients may experience different effectiveness from the use of NSAIDs. Although recommendations for individual selection of NSAIDs are classified as having a low level of evidence (D, expert opinion), their clinical significance remains high, since they contribute to a personalized approach to treatment [4]. There are studies that show that treatment may require replacing more than two NSAIDs in search of the optimal anti-inflammatory agent for a particular patient [4]. Thus, there is a substitution of the concept of rationality of empirical selection of NSAIDs or the lack of priority in choosing the first "starting" NSAID with the concept of equal effectiveness of drugs. Equal efficacy at the group level is not equal efficacy at the patient level, therefore any NSAID may be the drug of first choice for an individual patient.
The aim of the study was to study the attitude of patients to NSAID pharmacotherapy, evaluate the effectiveness of drugs and identify factors influencing their choice.
Materials and methods of the study: a questionnaire of 19 questions was developed concerning various aspects of the use of NSAIDs, including efficacy, concern about adverse drug reactions, level of availability, recommendations of doctors, personal experience of treatment.
The study included a survey of 60 patients of the therapeutic, cardiology, endocrinology, pulmonology, neurology and gastroenterology departments hospitalized in the Private Healthcare Institution "KB "Medicine of Russian Railways" in Voronezh" in December 2024. The results obtained are presented in a table, statistical processing was performed using SPSS, version 27.0.
Research results. The survey was conducted among four groups of patients: 18-30 years old (3 patients), 31-45 years old (9 patients), 46-60 years old (27 patients), over 60 years old (21 patients), of which 30 patients were male, 30 patients were female, 40 people were employed, 19 patients were pensioners and 1 was unemployed.
According to the survey results, 49 people (81%) regularly used NSAIDs, 10 patients (17%) used NSAIDs only on the recommendation of a doctor, 1 respondent (1.7%) - did not answer the question about taking NSAIDs.
The majority of respondents used NSAIDs as needed (74%), 12% of respondents rarely took NSAIDs, 6% of respondents used the drugs several times a week, and an insignificant part (8%) used them on a daily basis. When answering the questionnaire, patients indicated that they took the drugs mainly to relieve pain. The clinical effect of NSAIDs was determined, first of all, in patients with diseases of the musculoskeletal system (joint pain - 24 patients, back pain - 25 patients, osteoarthrosis + osteochondrosis 8 patients, myalgia and gout - 8 patients), as well as headache - 7 patients. When answering the questionnaire, patients indicated the most frequently used NSAIDs, including nimesulide (18 patients, 30%), diclofenac (13 patients, 21.6%), ketoprofen (13 patients, 21.6%), ketorolac (12 patients, 20%), meloxicam (12 patients, 20%), ibuprofen (11 patients, 18.3%). Other drugs were rarely used - indomethacin (4 patients 6.6%), aceclofenac (1 patient 1.6%).
When choosing a drug and treatment regimen, the most common factors were the patient's condition and the goals of therapy. The decisive factors in choosing a drug were their effectiveness (42 patients, 70%), safety (17 patients, 28%), cost (12 patients, 20%), dosage form (4 patients, 6.6%), and the number of doses per day (3 patients, 5%).
In some cases, patients indicated the priority of the dosage form (suppositories, solution for local use, spray for local use), as well as the awareness of the drug, taking into account advertising on television and the Internet.

The quality guarantee when choosing a drug for patients was the drug's fame (29 patients 48%), foreign production (11 people) or domestic production (12 patients).
Among the factors influencing the choice of a drug were the fame of the manufacturer (11.6%) and advertising (3.3%). The cost of the drug was not indicated among the respondents' answers.
Contact with the healthcare system was an important factor in choosing drugs. Thus, 45 patients (71%) took NSAIDs based on a doctor's recommendation, and 6 patients (10%) based on a pharmacist's recommendation. Independent choice was indicated by 8 people (13%), on the advice of relatives 5 patients (8%), on the advice of friends: 3 patients (5%).
The survey results showed that most patients prefer to take drugs as needed and act on the basis of doctors' recommendations. In this case, the assessment of the effectiveness of the analgesic effect of drugs in patients was distributed as follows: very high (2%), high (20%), moderate (70%), low 2 (4%).
With the systemic use of NSAIDs (orally, parenterally and rectally), patients associated the need to take into account adverse reactions, assess the risk of occurrence and the need for preventive measures.
The mechanism of toxicity caused by NSAIDs usually leads to excessive inhibition of COX, which leads to a decrease in the synthesis of prostaglandins [7]. These drugs can cause adverse effects from the gastrointestinal tract (GIT), urinary and cardiovascular systems, hematological and cardiovascular complications [1]. Long-term use of NSAIDs is also associated with the occurrence of nephrotoxicity, which ultimately leads to renal failure [6]. Gastrointestinal disorders are the most common, so in our study, we used this criterion to assess the frequency of side effects [5]. To the question "Have you had any abdominal pain after taking the drugs?" 9 patients (17%) gave a positive answer. Abdominal pain occurred once in 3 respondents (5%) and several times in 10 people (18%). The majority of respondents - 43 patients (79%) - were aware of the possible risks and contraindications for the use of NSAIDs, which indicates public awareness of the consequences of taking NSAIDs.

A separate question was about the need to have anti-inflammatory drugs in home medicine cabinets. The majority answered positively - 56 patients (93%), willingness to read the instructions for use was demonstrated by 53 people (88%).
Thus, based on the data obtained during the survey, it was possible to find out that patients understand the importance of taking NSAIDs in the treatment of most feverish, inflammatory and pain syndromes. The vast majority of patients noted that it is necessary to have anti-inflammatory drugs in home medicine cabinets. The survey results demonstrated that the choice of drugs among patients is influenced by a number of factors, including personal preferences and recommendations of medical personnel. These data can be useful for an individual approach to therapy.
The survey results allowed us to identify the main reasons for choosing drugs. Patients' attitudes towards NSAIDs are largely determined not only by their clinical properties, but also by social and psychological factors. The availability of NSAIDs in pharmacies had an important influence. NSAIDs are a widely used group of drugs in all age groups. A feature of modern NSAIDs is the existence of a variety of dosage forms (tablets, suspensions), including for local use in the form of ointments, gels, sprays, as well as suppositories and drugs for parenteral administration. However, their prescription requires great attention and knowledge in order to individually select an effective and safe drug among many drugs [2]. Feedback from patients can help health care professionals more effectively approach the appointment of treatment, taking into account patient preferences. The data obtained in the course of our study are important for further research in the field of pharmacotherapy and can form the basis for developing recommendations to improve patient awareness and help them make a more informed choice of drugs.

About the authors

Amina Denisovna Dudnikova

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: maslo100115@mail.ru
ORCID iD: 0000-0003-2896-8761
Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Yana Viktorovna Osminina

Voronezh State Medical University named after N. N. Burdenko

Email: yana.osminina03@gmail.com
ORCID iD: 0009-0009-6143-8704
Russian Federation, 394036, Voronezh, st. Studencheskaya, 10.

Ekaterina Andreevna Popova

Voronezh State Medical University named after N. N. Burdenko

Email: kate.200319@yandex.ru
Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

References