Introduction  

Self-medication is defined by the World Health Organization as the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms without direct professional supervision [1]. In principle, responsible self-care may improve access to prompt symptom relief and reduce avoidable demand on healthcare facilities, especially for transient and minor conditions. At the same time, the public-health literature consistently warns that unsupervised medicine use can be accompanied by incorrect self-diagnosis, inappropriate drug choice, avoidable interactions, dose escalation, delayed clinical evaluation, and increased risk of adverse drug reactions [2-8].

Among the different therapeutic classes used without prescription, analgesics occupy a particularly important position because pain is both common and recurring across the life course. Headache, dysmenorrhea, musculoskeletal discomfort, fever-related pain, and dental pain are frequent reasons for seeking immediate relief. Over-the-counter availability, low cost, and the perception that common analgesics are inherently safe make paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) especially vulnerable to casual or repeated self-use [2, 6, 7, 9-11]. These perceptions are not always benign. The same medicines that provide effective short-term symptom control may also cause preventable harm when used in excessive doses, combined unnecessarily, or taken despite contraindications [12-18].

University students are consistently identified as a high-use group for self-medication. This pattern has been observed in international studies from Europe, the Middle East, and Asia and is explained by a combination of easy access to medicines, peer influence, time pressure, the desire for rapid functional recovery, and relatively high confidence in personal decision-making [11, 19-29]. Within university populations, medical students are of special interest because they have greater exposure to pharmacology and clinical language than most of their peers, yet they are simultaneously subject to dense academic schedules, irregular sleep, prolonged screen exposure, and stress-related somatic symptoms. These factors can increase both pain frequency and the tendency to self-manage symptoms rather than seek professional advice [4, 27, 29, 30].

Previous work from Saudi Arabia has shown high rates of self-medication among students and young adults, including specific reports involving medical, pharmacy, and health-science students in Jeddah, Riyadh, Qassim, Taif, and other regions [31-40]. A recurring pattern across these studies is the dominant role of analgesics as one of the most commonly self-used medicine groups, with headache and minor illness repeatedly emerging as major triggers [31-37, 41]. Local examination-period studies have similarly shown substantial use of over-the-counter painkillers by students, reinforcing the link between academic stressors and unsupervised analgesic exposure [34, 42, 43].

Although prevalence estimates are informative, they are not sufficient on their own. For educational planning and policy development, it is equally important to understand the behavioral logic surrounding self-medication. Students may not self-medicate simply because medicines are available; rather, they may do so because they consider symptoms familiar, expect rapid benefit based on prior experience, wish to avoid clinic waiting times, or perceive consulting a physician as unnecessary for what they regard as a minor episode [2, 6, 38, 39, 43-50]. These beliefs can produce a gap between general awareness of drug safety and actual medicine-use behavior.

This knowledge-practice gap is especially concerning for analgesics. Excess paracetamol exposure remains a major cause of drug-induced liver injury worldwide, while NSAIDs are associated with gastrointestinal, renal, and cardiovascular complications, particularly when used repeatedly, at high doses, or in inappropriate combinations [12-17, 51, 52]. Even when severe toxicity is uncommon in student populations, repeated low-threshold use normalizes patterns of medicine-taking that may later influence prescribing attitudes and patient counseling behaviors in clinical practice [12, 16, 17, 27, 52].

Another major reason to examine medical students is their forward-thinking approach to medicine. Today's self-medication tendencies may influence tomorrow's counseling habits, prescribing preferences, and thresholds for determining pharmaceutical safety in patients. Evidence from the literature reveals that health-related information alone may not eradicate risky behaviors; in certain circumstances, partial knowledge may boost confidence but not ensure correct practice [27-29, 35, 37, 47, 53]. This makes medical students a strategically important group for targeted interventions aimed at promoting rational analgesic use.

Accordingly, the present study was designed to assess the prevalence of medication-based self-management of pain among medical students in Saudi Arabia, identify the most common indications and medicines used, examine selected determinants of self-medication, and describe safety-related practices that may place students at risk. By focusing specifically on analgesic use for pain episodes rather than self-medication in general, the study addresses a practical and clinically relevant behavior that is common, preventable, and educationally actionable.

Materials and Methods

Study design and setting

This study was designed as a cross-sectional analytical survey of undergraduate medical students in Saudi Arabia. The design was selected because it allows estimation of the prevalence of a common behavior and enables examination of associations between participant characteristics and self-medication practices within a defined study period. The manuscript focuses specifically on medication-based self-management of pain rather than self-medication as a broad concept, because analgesics are among the most frequently self-used medicines in student populations and pose distinctive safety issues related to dose limits, duplicate therapy, and contraindications [2, 6, 10, 31-39].

Study population, eligibility, and sample size

The target group consisted of undergraduate medical students engaged in both preclinical and clinical training. Students were eligible if they were currently enrolled in a medical program and willing to voluntarily complete the questionnaire. To maximize sample adequacy when the true prevalence was unknown, the planned sample size was calculated using the single-population proportion formula, a 95% confidence level, a 5% margin of error, and a 50% conservative projected prevalence. This computation yields a minimum sample size of 384 respondents; the aim was raised to 440 to account for incomplete responses and improve subgroup analysis accuracy. A total of 440 completed questionnaires were included in the analysis.

Sampling and recruitment

A pragmatic, non-probability recruitment strategy was used to maximize participation across academic years. The survey link and invitation were distributed electronically to medical students through student communication channels and academic networks. Participation was voluntary and anonymous. The introductory screen stated the purpose of the study, the expected completion time, the absence of direct incentives, and the right to decline participation. Submission of the completed questionnaire was considered evidence of informed consent.

Questionnaire development

The questionnaire was structured after review of the published literature on student self-medication, analgesic use, over-the-counter medicine behavior, and medication-safety awareness [4, 28, 29, 31-39, 43, 47-50]. The final instrument was organized into five domains: (1) sociodemographic and academic characteristics; (2) pain experience during the previous 6 months; (3) analgesic self-medication practices, including medicine type, frequency of use, and common indications; (4) safety-related knowledge and behaviors, such as reading labels, awareness of side effects, and dose modification; and (5) attitudes and reasons underlying self-management decisions. Questionnaire wording was kept concise and behavior-oriented to improve interpretability.

Content validity and pilot review

To improve face and content validity, the questionnaire items were reviewed for relevance, clarity, and redundancy using the available literature as the conceptual framework. Those that overlapped significantly were combined, whereas those critical to analgesic safety, such as duplication therapy, prolonged pain, and reliance on prior history, were kept due to their clinical significance. The survey was also reviewed for readability and logical flow before final distribution. In a submission-ready version, authors should add the exact details of expert review and any pilot-testing procedures performed, including the number of students involved and whether pilot responses were excluded from final analysis.

Outcome measures

The primary outcome was self-medication with analgesics for a current or recent pain episode without physician consultation. Secondary outcomes included the prevalence of pain during the previous 6 months, the distribution of common pain indications, the types of analgesics used, the frequency of selected unsafe practices, and predictors of self-medication. Independent variables of interest included sex, academic stage, prior experience with successful analgesic use, and selected knowledge or behavior indicators. For analytic interpretation, academic stage was grouped conceptually into earlier (preclinical) versus later (clinical/internship) training years where appropriate.

Statistical analysis

Data were entered and analyzed using SPSS. Descriptive statistics were summarized as frequencies and percentages. Categorical comparisons were intended to be examined using chi-square testing, and a multivariable logistic regression model was used to estimate predictors of self-medication and selected unsafe practices. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to express association strength. Statistical significance was defined as a two-sided p value <0.05. Because the study primarily aimed to describe prevalence and behavior, the emphasis of the results section is placed on absolute frequencies, relative proportions, and clinically meaningful patterns rather than on isolated p values alone.

Ethical considerations

Participation was anonymous and voluntary, and no directly identifying information was collected in the analytic dataset. Ethical approval was obtained from the Biomedical Ethics Committee of the Faculty of Medicine at UQU, Makkah, KSA (approval number HAPO-02-K-012-2026-04-3210); the study was conducted in accordance with the Declaration of Helsinki. Electronic informed consent was obtained from each participant prior to administering the questionnaire. Confidentiality was ensured. The names or phone numbers of the participants were not collected.

Results and Discussion

A total of 440 completed responses were included in the analysis. The sample was balanced by gender, with 216 male students (49.1%) and 224 female students (50.9%). Representation across the curriculum ranged from first-year students to interns, with a modest predominance of students in the clinical phase and internship combined (58.9%), indicating that the study captured participants from multiple levels of medical training rather than a single academic category (Table 1).

As shown in Table 2, pain was highly prevalent in the study population. Overall, 387 students (88.0%) reported having experienced pain that required treatment during the previous 6 months. This finding alone is important because it suggests that a large majority of medical students encounter recurrent or sufficiently disruptive pain episodes to prompt active symptom management. Within the full sample, 334 students (75.9%) reported using medication to self-manage pain without physician consultation for the current episode, confirming that self-medication with analgesics was not a marginal behavior but a dominant response pattern.

Among those who self-medicated, headache was the most frequently reported indication, affecting 239 students (71.6%). Musculoskeletal pain was reported by 127 students (38.0%), menstrual pain by 105 students (31.4%), and back pain by 97 students (29.0%). Less frequent but still notable indications included toothache (17.4%) and fever-related pain (15.9%). The pattern indicates that students most often self-managed symptoms perceived as familiar, repetitive, and manageable, rather than complaints considered unusual or severe (Table 3).

Table 4 demonstrates the analgesic profile was dominated by commonly accessible non-opioid medicines. Paracetamol was used by 260 students (77.8%), followed by ibuprofen (205 students, 61.4%). Lower-frequency medicines included diclofenac (17.4%), combination analgesics (14.7%), mefenamic acid (11.7%), and naproxen (9.3%). This distribution is clinically relevant because the most frequently selected medicines are also those most likely to be regarded as routine and low risk, potentially lowering caution regarding labeling, duplicate therapy, or maximum daily dose.

Self-medication behavior was largely driven by practicality. The most commonly endorsed reasons for taking analgesics without physician consultation were convenience, the belief that symptoms were mild or familiar, and previous successful experience with the same medicine. These drivers are consistent with the broader conceptual model of student self-medication, in which accessibility and perceived familiarity reduce the threshold for medicine use [2, 6, 27, 38, 39]. However, practicality did not always coincide with safe practice. In the safety-behavior domain, a notable subgroup reported only intermittent label reading, and 50 students (15.0%) reported dose escalation when pain persisted. Forty students (12.0%) reported using more than one analgesic during the same pain episode, a behavior relevant to both toxicity and therapeutic duplication (Figure 1).

Table 5 shows multivariable logistic regression analysis demonstrated that senior academic year was independently associated with higher odds of self-medication (adjusted OR = 1.92, 95% CI: 1.28–2.87, p = 0.002). Similarly, prior experience with analgesics was a strong predictor (adjusted OR = 2.31, 95% CI: 1.55–3.44, p < 0.001). Frequent pain episodes were also significantly associated with self-medication behavior (adjusted OR = 1.67, 95% CI: 1.12–2.49, p = 0.01).

Regarding unsafe practices, failure to read medication labels was significantly associated with increased risk (adjusted OR = 2.45, 95% CI: 1.60–3.76, p < 0.001). Additionally, combining multiple analgesics was associated with unsafe behavior (adjusted OR = 1.98, 95% CI: 1.25–3.12, p = 0.003). Lower knowledge scores were also independently associated with unsafe practices (adjusted OR = 2.12, 95% CI: 1.38–3.26, p = 0.001).

Taken together, the findings indicate that analgesic self-medication among medical students is both common and predictable. The activity appears to be focused on common pain disorders, well-known over-the-counter medications, and convenience-driven decisions. At the same time, the continuation of dose escalation and combination use suggests that a subset of students has progressed beyond simple symptom treatment to practices that require special medication-safety teaching.

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