Sex Differences in the Use of Pain Medication in Sweden and Denmark Abstract Background: Pain is a multifaceted experience and understanding its mechanisms and effective treatment methods being of paramount interest. Sex differences in pain perception, treatment, and response are increasingly recognized as pivotal areas of investigation. Aim: This study aims to compare the usage patterns of analgesic medications between Sweden and Denmark, focusing on sex and gender differences. Method: A quantitative cross-sectional study utilizing aggregated individual-level data from national registries in Sweden and Denmark was conducted. The study focused on prescribed analgesic medications, including NSAIDs (M01A), paracetamol including combinations (N02BE), salicylic acid and derivatives (N02BA), and opioids (N02A), identified by their respective ATC- code. The analysis encompassed adult individuals aged 25 and above, in total and divided into three age groups. The studied measure was period prevalence, defined as the number of individuals per 1000 inhabitants that purchased at least one prescription during the year. Differences between men and women were calculated as risk ratios (RRs). Data were collected for the years 2022 and 2010 to provide a comparative analysis over time. Results: Clear disparities in analgesic medication usage between men and women were observed in both countries in 2022, with women generally exhibiting higher utilization rates compared to men. In Sweden, risk ratios (men/women) for NSAIDs, opioids, salicylic acid derivatives, and paracetamol including combinations were 0.76, 0.75, 0.50, and 0.63, respectively. In Denmark, similar trends were observed. The risk ratios for NSAIDs, opioids, salicylic acid derivatives, and paracetamol including combinations were 0.83, 0.78, 0.76, and 0.70, respectively. Analysis of trends from 2010 to 2022 showed change in sex differences in drug use. Furthermore, variations in usage patterns were noted between age groups. Conclusion: This study underscores the presence of sex disparities in analgesic medication usage in Sweden and Denmark in 2022. These disparities persist across different age groups and between the two countries.

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Bakgrund: Receptfria smärtstillande läkemedel (rslm) är lättåtkomliga läkemedel som unga individer kan självmedicinera med. Psykisk ohälsa bland unga ökar, vilket skulle kunna påverka användandet. Skolsköterskor har ofta god insyn i skolelevers livssituation och kan ha en god uppfattning om hur skolelever använder rslm. Syfte: Att undersöka skolsköterskans uppfattning om användandet av rslm bland skolelever i Uppsala kommun samt jämföra uppfattningar mellan skolsköterskor i grundskola och på gymnasiet. Metod: En deskriptiv och komparativ tvärsnittsstudie med kvantitativ ansats. Urvalsgruppen var 62 skolsköterskor i Uppsala kommun. En webbenkät användes för datainsamling och data analyserades i huvudsak med deskriptiv statistik. Resultat: Majoriteten av skolsköterskorna visste inte om eleverna använder rslm på rätt indikation, i rätt dos eller om en ökning skett de senaste tio åren. Majoriteten (59 %) uppfattade att det ofta är samma elever som efterfrågar rslm. Det fanns signifikant skillnad i några uppfattningar mellan skolsköterskorna på grundskolan och gymnasiet men antalet deltagare var lågt, vilket gör resultatet av jämförelse osäkert. Huvudvärk uppfattades som den vanligaste orsaken till efterfrågan av rslm (86,8 %). De vanligaste orsakerna till huvudvärk hos elever uppfattades vara missad måltid (64,9 %) och dålig sömn (64,9 %). De vanligaste orsakerna till generellt magont hos elever uppfattades vara missad måltid (45,9 %) och till nackvärk uppfattades vara användande av mobil, dator och surfplatta (52,9 %). Slutsats: Många skolsköterskor hade ingen uppfattning om elevers användande av rslm. Elever har smärttillstånd som kan bottna i flera orsaker. Fler studier inom det här ämnet behövs för att kunna identifiera hur användandet av rslm ser ut bland unga. / Background: Over-the-counter analgetics are easily accessible and something that young individuals can use for self-medication. Mental health problems increase among young individuals which can affect their use. School-nurses often have a good insight into the lives of school-children, and can therefore identify how school-children use over-the-counter analgetics. Aim: To examine school-nurses perceptions about the use of over-the-counter analgetics among school-children in the community of Uppsala and compare perceptions between school-nurses in elementary schools - and in the high schools. Method: A descriptive and comparative cross-sectional study with a quantitative approach. The sample was 62 school-nurses in the community of Uppsala. Data was collected by an internet-based survey and was mainly analyzed with descriptive statistics. Results: The majority of the school-nurses don’t know if over-the-counter analgetics are used properly, as prescribed, with the correct doses, or if the use has increased over ten years. The majority perceive that it's often the same school-children that request over-the-counter analgetics. There was a significant difference in some perceptions, but due to the low participation, the value of significant data can be vague. Headaches was the most common causes to request over-the-counter analgetics (86,8 %). The perceptions of the most common causes of headaches among school-children were skipping meals (64,9 %), and sleeping problems (64,9 %). The most common causes of general stomach-aches were skipping meals (45,9 %), the most common causes of neck pain were the use of cellphones, computers and tablet devices (52,9 %). The majority of the school-nurses don’t know if over-the-counter analgetics are used properly, as prescribed, with the correct doses, or if the use has increased over ten years. The majority perceive that it's often the same school-children that request over-the-counter analgetics. There was a significant difference in some perceptions, but due to the low participation, the value of significant data can be vague. Conclusion: Many school-nurses are interrogative to questions about school-children’s use of over-the-counter analgetics. School-children have pain conditions for several causes. More studies about this subject are needed to be able to identify the use among school-children.

Syfte: Syftet med denna studie var att jämföra graden av smärta och illamående hos två patientgrupper inom ortopedi som smärtlindrades med tablett Dolcontin/Depolan/Morfin eller tablett Oxycontin/Oxynorm postoperativt dag 0, 1 och 2. Syftet var även att undersöka vilka riskfaktorer enligt Apfel Risk Score som kan påverka grad av illamående samt att undersöka om en korrelation fanns mellan preoperativ information och incidensen av postoperativt illamående och kräkning (PONV). Metod: En komparativ studie med kvantitativ ansats. Data samlades in genom två olika enkäter, varav en enkät fylldes i av patienterna och en enkät av sjuksköterskorna. 48 patienter inkluderades i studien, 24 per substans. Både kvinnor och män som genomgått elektiva knä- eller höftarteroplastikoperationer deltog i studien och de var mellan 31-77 år. Mätinstrumentet som sjuksköterskorna använde sig av för att skatta smärta och illamående var visuell analog skala (VAS). Data analyserades i Statistic Package for the Social Science (SPSS) 10.1 med x2-test, oberoende t-test samt Mann-Whitney U-test. Resultat: Resultatet i studien visade att inte fanns någon signifikant skillnad gällande smärta och de två substanserna. Det fanns en signifikant skillnad gällande illamående och de två substanserna. Inget signifikant samband påvisades mellan illamående och riskfaktorerna i Apfel Risk Score. Det fanns heller inget signifikant samband mellan incidensen av PONV och patientens upplevelse av att ha fått noggrann information preoperativt. Slutsats: Då dokumentationen av smärta och illamående enligt VAS på sjuksköterskeenkäterna var bristfällig, kan inga säkra slutsatser dras. Mer forsknings krävs således inom detta område. / Aim: The aim of this study was to compare the rating of pain and nausea in two groups of patients in orthopedics that was pain relieved with tablet Dolcontin/Depolan/Morphine or tablet Oxycontin/Oxynorm postoperative day 0, 1 and 2. The aim was also to investigate the risk factors according to Apfel Risk Score that may affect the degree of nausea and to investigate whether a correlation existed between preoperative information and the incidence of postoperative nausea and vomiting (PONV). Method: A comparative study with quantitative approach. Data were collected through two different questionnaires, one that was filled out by the patients and the other questionnaire by the nurses. The study included 48 patients, 24 per substance. Both men and women, between 31-77 years old, who would undergo elective knee or hip replacement surgery, participated in the study. The measuring instrument that the nurses used to estimate the pain and nausea were visual analogue scale (VAS). Data were analyzed in the Statistic Package for the Social Science (SPSS) 10.1 with the x2-test, independent t-test and Mann-Whitney U-test. Results: The results of the study showed that there was no significant difference regarding pain and the two compounds. There was a significant difference regarding nausea and the two compounds. No significant correlation was found between nausea and the risk factors in the Apfel Risk Score. There was no significant correlation between the incidence of PONV and patient experience of receiving accurate information preoperatively. Conclusion: As the documentation of pain and nausea according to VAS on the nursing surveys were poor, no firm conclusions can be drawn. Further studies are necessary to confirm the results of this study.

Introduction: The kidneys' ability to filter drug substances deteriorates with age. Some diseases accelerate this degradation. Patients with renal impairment are at increased risk of drug-related adverse reactions if dose adjustments are not made. Aim: To investigate the purchase and dosage of newly introduced opioids, gabapentinoids and NSAIDs between 2014 and 2019 for patients with impaired kidney function in the Stockholm Region. Method: A register-based cross-sectional study where data has been obtained from the database SCREAM (The Stockholm CREAtinine Measurements project). All patients ≥ 18 years of age, who live in Stockholm and have performed at least one creatinine measurement from January 2013 and received a prescription for selected drugs were included. The number of people and the dosage (DDD/prescription) were studied annually, by age, sex, and CKD. Results: The total number of patients was 362,964 with a mean age of 56 (SD 19) years. The study included 202,762 women (56%) and 160,201 men (44%). The mean value of eGFR was 88 (SD 24). Gabapentinoids were prescribed significantly less than NSAIDs and opioids, however, prescribing increased between 2014-2018. It was the only class of drugs with a clear reduction in dosage with respect to CKD level. NSAIDs were prescribed on few occasions to patients with impaired renal function, at the same time a reduction in the total number of prescriptions was seen between 2014-2018. No major difference in dosage was seen based on the patient's CKD level. Opioids were prescribed on most occasions with an increase in the number of prescriptions between 2014-2018. Only minor differences in dosage were noted between the different CKD levels. However, for all CKD levels, there had been a gradually reduced dosage from 2014 to 2018. Conclusion: Patients with renal impairment belong to a fragile group with a number of different comorbidities. Painkillers are prescribed on fewer occasions to patients with renal impairment. Prescribers, however, do not appear to adjust the dose with respect to renal function when re-introducing NSAIDs and opioids