Management of musculoskeletal pain in retail drug outlets within a Nigerian community: a descriptive study

OBJECTIVE: This work aimed to describe attitudes and practices of both community pharmacies and patent and proprietary medicine vendor (PPMV) outlets towards over-the-counter (OTC) analgesic use for musculoskeletal pain states within Zaria, Nigeria. METHODS: The study was carried out in 2 phases from May to August 2016. Phase one was a cross-sectional survey of 40 retail drug outlets (10 community pharmacies and 30 PPMVs). A simulated patient scenario of a young adult male complaining of acute onset back pain was used to collect data on the type and quality of analgesic recommended, duration of consultation, as well as nature of information provided during the drug dispensing process. The second phase involved semi structured interviews with 7 drug vendors (4 pharmacists and 3 patent medicine vendors). The interviewees were asked questions to assess their knowledge of analgesics as well as what type of analgesic they would recommend in three hypothetical patient scenarios. RESULTS: A wide variety of therapeutic agents were recommended for the simulated patient. Majority of these drugs were oral analgesics and contained NSAIDS either alone or in combination. Less than half of both patent medicine outlets and pharmacies (26.7% and 40% respectively) provided the simulated patient with information on duration of therapy, and asked the patient questions about their past medical and medication history (30% and 33.3% respectively). All analgesics purchased from the pharmacies were registered with the Nigerian drug regulatory agency and had expiry dates compared to only 66.7% and 90% of those bought from patent medicine outlets. Interviewed drug vendors admitted to obtaining a large amount of their knowledge on analgesics from drug information leaflets and prior learning. They also showed some knowledge deficits when questioned on side effects of analgesics and appropriate drug selection in the hypothetical scenarios. CONCLUSIONS: There are problems with both the OTC analgesics recommended, and the counselling provided for these medicines by drug vendors within the Zaria community. While both pharmacies and patent medicine outlets had shortcomings in several of the areas assessed by the simulated patient, the pharmacies performed better.