Over the counter (OTC) analgesics are products which are widely available and publicly accessible. Contemporary healthcare policy encourages patients to take greater control over their health care and recovery [Department of Health and Children 2001. Quality and Fairness - A Health System for You, Health Strategy. Dublin, Stationery Office.]. Over the counter medication offers injured patients a degree of control over their pain experience, preventing unnecessary pain on transit to an Accident and Emergency (A&E) department. In terms of availability, the range and variety of analgesics available is ever increasing, as more and more ingredients are downgraded from prescription only medicine (POM) to OTC status. However, despite the increase in the availability of OTC analgesia and an emphasis on patient empowerment, the majority of patients continue to present to A&E without taking any prior analgesia. In a study of 391 patients, 81% of patients took no analgesia prior to attending the A&E department [Emergency Nurse 9 (2002) 36]. Pain, as Cooper [Cooper, A., 1994. Pain Assessment in accident and Emergency. Accident and Emergency Nursing 2(1) (1994) 103] has noted, prompts people to make a rational decision to attend the A&E department. This literature review explores possible explanations as to why patients do not take OTC analgesia as a first line step in pain management.