Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study

BMJ Open. 2023 Mar 17;13(3):e066058. doi: 10.1136/bmjopen-2022-066058.


Objective: Frequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain.

Design: A cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA.

Setting and participants: All 10 608 adolescents aged 13-19 years in a region of Norway were invited in this school-based survey, participation rate was 76%.

Outcome measure: Frequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses.

Results: Trauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose-response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed.

Conclusion: Trauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.

Keywords: Child & adolescent psychiatry; MENTAL HEALTH; NEUROLOGY; PAEDIATRICS; PUBLIC HEALTH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Analgesics / therapeutic use
  • Cross-Sectional Studies
  • Headache / chemically induced
  • Headache / epidemiology
  • Humans
  • Musculoskeletal Pain* / drug therapy
  • Musculoskeletal Pain* / epidemiology
  • Nonprescription Drugs


  • Analgesics
  • Nonprescription Drugs