NSAIDs reign, naturals rise

Traditional OTC pain relievers remain popular, but topical and natural solutions are gaining traction.
Kathie Canning
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When day-to-day life becomes a pain in the neck, consumers want fast relief. And sore necks—along with aching backs, throbbing heads and other hurting body parts—equate to big business for manufacturers of over-the-counter pain-relief medications and the retail outlets that sell them.

According to a January 2023 report from London-based Brandessence Market Research, the global OTC analgesics market was worth $26.5 billion in 2022. Moreover, the market is expected to realize a compound annual growth rate of 5.5% between 2022 and 2029.

“The increasing geriatric population base, growing prevalence [of] chronic diseases and rising self-medication trends are creating lucrative opportunities for this industry vertical to amass notable gains,” the market research firm said.

NSAIDs remain popular

The nonsteroidal anti-inflammatory drug (NSAID) segment is one of the fast-growing segments in the OTC analgesics space, Brandessence noted.

And ibuprofen, aspirin and naproxen are the most common NSAIDs, the Cleveland Clinic reports. Consumers rely on them to treat a number of painful conditions, including rheumatoid arthritis, osteoarthritis, muscle aches, backaches and more.

In late 2020, GlaxoSmithKline (GSK), whose U.S. division is in Durham, N.C., interrupted this category with the debut of Advil Dual Action tablets, which feature a combination of ibuprofen (150 mg) and the non-NSAID pain-reliever acetaminophen (250 mg).

“For decades, many consumers have been using ibuprofen and acetaminophen to get the benefits of both active ingredients when safely treating their headaches, muscle aches, backaches, arthritis and other joint pain,” Franck Riot, head of R&D for GSK Consumer Healthcare, said following FDA approval of the tablets. “Advil, the No. 1 selling OTC pain reliever, will offer U.S. consumers the first-ever alternative option—a single, fixed-dose combination pain reliever.”

Last summer, following the demerger of the GSK Consumer Healthcare business,the consumer-health company Haleon launched. The new company, based in Weybridge, England, acquired the Advil brand (as well as some other GSK brands). And in late 2022, it announced the availability of Advil Dual Action in Canada.

Dublin-based Perrigo Company PLC, meanwhile, recently announced the receipt of final approval for its Abbreviated New Drug Application for the equivalent of the Advil tablets. The company said it expects to launch the product this spring, opening up store-brand product-development opportunities for drug store and other retailers.

“This approval was received on the first day possible following the expiration of the marketing exclusivity for Advil Dual Action tablets,” said Jim Dillard, executive vice president with Perrigo and president of the company’s Consumer Self-Care Americas.

Not for everyone

OTC NSAIDs, alone or in combination with OTC non-NSAIDs, are not for everyone, how- ever. Outside of aspirin, all NSAIDs appear to be associated with a higher risk of cardiovascular problems, Harvard Health Publishing reported.

In addition, they might exacerbate the situation for people with osteoarthritis. Specifically, such drugs could worsen inflammation in the knee joint over time, reported the Radiological Society of North America (RSNA), citing a new study from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco.

The study included 277 participants with moderate to severe osteoarthritis and sustained NSAID treatment for at least one year between the baseline and four-year follow-up. They were compared to a group of 793 control participants who were not treated with NSAIDs. All participants underwent “3T MRI” of the knee initially, RSNA noted, and again after four years. Images were scored for biomarkers of inflammation.

The results showed no long-term benefit of NSAID use. Moreover, joint inflammation and cartilage quality were worse at baseline for the participants taking NSAIDs than for the control group, RSNA said, and worsened at four-year follow-up.

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A topical push

It should come as no surprise, therefore, that some consumers are moving away from NSAIDs—and from oral OTC pain relievers in general—and are seeking topical solutions. 

According to a September 2022 report from India’s Quintana Research and Consulting, growth drivers for topical pain-relief solutions include fewer adverse effects than those of traditional oral medications, rising demand among athletes, an increasing number of elderly people and the prevalence of arthritis.

“Customers have pill fatigue,” said Dason Williams, chief operating officer of Clavél Corp., Abilene, Texas. “They don’t want to take multiple pills that can damage their liver and will conflict with other treatment options they are doing.”

Although external analgesics consistently outperformed the overall OTC and health-and-beauty-care categories for a number of years, they saw some softness in 2022, Jim Lepis, senior director for Florham Park, N.J.-based Hisamitsu America Inc., noted.

“A key factor behind the softness appears to have been the exceptional prior year and some pandemic-related shopping dynamics that did not continue,” he said. “As we’ve turned the page to 2023, the category is once again growing nicely.”

The aging U.S. population bodes well for future growth, too, Lepis added. Moreover, consumers not only are becoming more educated about external analgesics’ benefits, but they also are on the receiving end of more external-analgesic recommendations from the medical community.

“Another trend that might surprise people is that the convenient and no-mess patch form is the largest segment, exceeding both gel form and cream form,” he said. “The roll-on form has become another popular no-mess option that has been a key contributor to recent category growth.”

On the patch front, Hisamitsu America recently introduced the Salonpas Lidocaine FLEX patch. Lepis said the nonaqueous pain-relief patch contours to the body and stays in place during body movements.

External treatments continue to be popular within the first-aid space, too. Data from global market research firm Mintel show that 90% of consumers desire a fast-acting formula with multiple benefits, noted Jim Creagan, president of Cornwall, N.Y.-based CrossingWell Consumer Health (formerly Randob Labs).

Creagan said his company’s Sting-Kill and Chiggerex products include benzocaine for instant pain relief and also provide itch-relief benefits. The company’s Bacitraycin Plus first-aid ointment, meanwhile, not only relieves pain, but also contains bacitracin to kill germs and aloe to soothe.

Natural boasts appeal

Internal or external, OTC pain relievers also are trending toward all-natural formulations, including those using plant-based ingredients. But this trend is still emerging, Erick Dickens, an executive with Phoenix-based Healist Naturals, pointed out. Healist Naturals is a new company that purchased the Level Select topical pain-relief brand, as well as other OTC brands.

“Consumers are increasingly aware of the ingredients used in the products they put in and on their body and are ready for effective choices in OTC pain relief,” he noted.

Healist Naturals’ newly introduced Level Select OTC product lineup—including muscle rub lotion, sports therapy cream, massaging roll-on gel and more—contains natural menthol and camphor. Dickens calls the line “a breakthrough innovation in plant-based wellness” that provides fast pain relief.

“These plant-based ingredients effectively address common forms of discomfort such as muscle soreness, joint pain, backaches and other minor aches and pains,”Dickens said.“Along with menthol and camphor, Level Select OTC products contain other beneficial ingredients like MSM, comfrey, horse chestnut and more.”

Williams agreed that consumers are moving more toward natural “non-drug” items on the topical side. He pointed to data from Chicago-based market research firm IRI showing that growth for the “not stated category” outpaced “the drug items with capsaicin, diclofenac, lidocaine and menthol stated on the Drug Facts panel” for the 52 weeks ending Jan. 1, 2023.

For its part, Clavél Corp. recently added a 3.4-oz. bottle with a massager top to its 100% natural Blue Stop Max muscle and joint gel line, which features natural ingredients such as emu oil, coconut oil and aloe vera. Williams said the format is good for air travel, trips to the gym and more.

Consumers, however, might need some convincing when it comes to natural pain-relief formulations—be they internal or external. Product efficacy still trumps all other considerations.

“While many consumers would prefer to buy a product with naturally derived active ingredients, they believe this benefit requires them to compromise efficacy,” Dickens said.

dermoplast teaser

Product picks

Dermoplast 3-in-1 Medicated First Aid Cloths
SRP: $12.99
Dermoplast introduced Dermoplast 3-in-1 Medicated First Aid Cloths. The cloths feature a sting-free formula with first-aid benefits to clean wounds, prevent infections and relieve pain while killing 99% of germs. The cloths feature 10% benzocaine and soothing aloe. They are individually wrapped, making it convenient to disinfect and ease the pain of cuts, wounds and burns while on the go. They retail in a 10-ct. box.

med terra teaser

Medterra Natural Pain Relief Capsules
SRP: $49.99
Medterra launched Medterra Natural Pain Relief in a capsule format. A natural alternative to traditional pain relievers, the product, sold in 30-ct. bottles, is said to be a clinically proven plant-based pain reliever that alleviates muscle pain, joint stiffness and inflammation without the negative side effects often associated with OTC options. It combines inflammation-reducing turmeric and Levagen+ PEA (palmitoylethanolamide), a more bioavailable form of regular PEA that is clinically proven to reduce minor aches and pains in as little as three days when used consistently.

icy hot teaser

Icy Hot Pro
SRP: Starting at $13.99
Sanofi Consumer Healthcare introduced Icy Hot Pro, a line of topical products designed for muscles and joints that have been pushed to their limits. The line combines two maximum- strength pain relievers: 16% menthol and 11% camphor. It is available in patch, no-mess (massage applicator), cream and dry spray formats. Of note: Product of the Year USA,the largest consumer-voted awards program centered around product innovation, named Icy Hot Pro the “Topical Pain Relief” category winner in its 2023 Product of the Year Awards.

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