Americans prefer education over restricted access to over-the-counter (OTC) pain medications, according to a recent survey. To ensure patients are able to make good, autonomous decisions, experts suggest the following:

  • Providers need to be well-educated in pain management.
  • Patients need a good understanding of their condition and treatment options.
  • Patients need education to avoid misuse of acetaminophen.


Americans prefer education over restricted access to over-the-counter (OTC) pain medications, according to a recent survey conducted by the Washington, DC-based Alliance for Aging Research. Of 1,600 individuals surveyed:

  • Seventy-five percent of respondents under age 60, and 70% of respondents over age 60, believe that the FDA should not change its policies to require a doctor’s prescription to buy extra-strength Tylenol or an equivalent store brand.
  • Eighteen percent of respondents age 60 and over encounter bad or severe pain; 37% have daily pain. Seventy percent of this age group uses OTC pain medication.

“We thought it was interesting to see that three-quarters of respondents under age 60 prefer education to government restriction as a way to protect people from acetaminophen overdose,” says Susan Peschin, MHS, the Alliance’s president and CEO.

Due to concerns regarding misuse and unintentional overdose of acetaminophen, the FDA has considered restricting access to some OTC medications containing acetaminophen, including the possibility of requiring a prescription for products that are currently OTC.

“However, this could have the unintentional effect of shifting individuals to other pain relievers that may be contraindicated for them,” says Peschin. Some survey respondents who stated they would change to a different pain reliever also reported having been diagnosed with conditions, such as cardiovascular disease or diabetes, in which other pain relievers are contraindicated.

“Overdose or overuse of acetaminophen is a common cause of acute liver failure and can occur after one very large dose of acetaminophen,” says Peschin. “However, when used as directed, acetaminophen is safe and effective.”

It’s important to remember that persistent pain is debilitating, especially for older adults, says Peschin. “Hyped-up messaging about the risks of pain medication is one of the reasons why older patients with persistent pain are fearful of treatment and are too often undertreated,” she says.

While healthcare providers want to protect patients from unintentional harm due to overdose or misuse, they also need to give their patients the benefit of the doubt that they will make the right decisions when given adequate information about dosage and risks, according to Peschin.

“Optimal pain management is what prescriptive opioids and other medications are fundamentally about,” says Esther Bernhofer, PhD, RN-BC, a senior nurse researcher in the Cleveland (OH) Clinic’s Office of Nursing Research and Innovation.

Ideally, a well-educated patient is treated by a provider who is well-educated in their condition and pain management options, says Bernhofer. “The prescriptive medications that arise out of that patient-provider relationship are then well-thought-out and the safest they can be,” she says. “The patient should then be able to obtain those medications without an arbitrary restriction from a pharmacy.”

If care providers are not well-educated in pain management, cautions Bernhofer, they cannot provide the patient with the proper information to make good, autonomous decisions.

“It is morally wrong to put a patient in the position of making a decision when the provider himself has a limited amount of knowledge on how to treat a patient with complicated pain issues,” says Bernhofer.


  • Esther Bernhofer, PhD, RN-BC, Senior Nurse Researcher, Office of Nursing Research and Innovation, Cleveland (OH) Clinic. Phone: (216) 445-5269. Email: bernhoe@ccf.org.