econintersect .com

FREE NEWSLETTER: Econintersect sends a nightly newsletter highlighting news events of the day, and providing a summary of new articles posted on the website. Econintersect will not sell or pass your email address to others per our privacy policy. You can cancel this subscription at any time by selecting the unsubscribing link in the footer of each email.

posted on 12 February 2017

Are Over-the-counter Painkillers A Waste Of Money?

from The Conversation

-- this post authored by Jonathan Silcock, University of Bradford

Simple painkillers (such as aspirin, paracetamol and ibuprofen) are widely bought over the counter and prescribed by doctors. But the stark truth is that most of these medicines don't work very well.

Professionals can't be satisfied advising consumers and patients to take ineffective medicines. And consumers and patients can't be happy that they're spending cash or NHS resources on something that doesn't do the job. But those with minor ailments who opt for such drugs aren't necessarily wasting their money - and may well be saving yours by reducing the burden on health services.

An evidence-based approach to pain relief must consider realistic alternatives. Trials demonstrate that simple over-the-counter (OTC) painkillers, such as paracetamol for low back pain and aspirin for episodic tension-type headaches in adults, work no better than placebo. But in practice, we need to consider how harmful this really is - and what people would do if they weren't popping their favourite pills.

Cochrane reviews are internationally-recognised systematic reviews. The most recent review of asprin for the treatment of occasional, acute, tension-type headache tells us that patients taking active medication are unlikely to be pain free. However, over half the patients taking aspirin were satisfied with their treatment, as were one third taking placebo.

Similarly, in a Cochrane review of paracetamol for the treatment of acute low back pain, 4g of paracetamol daily was found to be no more effective than placebo.

In both studies, active and placebo treatments had similarly low rates of side-effects.

More placebo, please

This isn't a good situation, but the placebo effect itself is often overlooked or treated with disdain. Which is a pity - it could be better employed in the fight against pain. A 2002 review of placebo effects in clinical pain killer trials concluded:

If the factors that contribute to placebo analgesia are identified, they could be optimised in clinical practice whereby the general effectiveness of pain treatments could be enhanced.

And placebo effects were greater when studies specifically tried to investigate how placebos work. In another context, a 2009 meta-analysis of anti-depressant trials concluded:

The placebo effect accounted for 68% of the effect in the drug groups. Whereas clinical trials need to control the placebo effect, clinical practice should attempt to use its full power.

Patient demand for pain relief in the UK is clear, around £575m a year is spent on OTC analgesics and another £567m on analgesics prescribed in primary care. The primary care spend includes £90m on products that could be bought OTC and £115m on compound painkillers that are the next step up the pain ladder.

It could all be in the mind. Shutterstock

Indeed, people may be willing to pay significant sums for pain relief, which is a measure of economic benefit - a few pounds to relieve everyday pain, tens of pounds to relieve post-operative pain, and hundreds of pounds to relieve chronic pain.

But the current supermarket price for paracetamol is little more than 1p per tablet - and stronger painkillers use codeine and related drugs, which significantly increase the risk of harmful side-effects.

For acute pain, simple safe painkillers are cheap (it's certainly worth buying generic rather than more expensive branded varieties) and promote active self-management of minor ailments. They may also help to engage the placebo effect. The evidence for effectiveness beyond the placebo effect is mixed (as the Cochrane reviews demonstrate), but doing something does have an effect and painkillers may actively help in some cases.

When people buy these painkillers, they also save the NHS - and taxpayers - the expense of visiting a doctor and having them prescribed. Generic paracetamol costs 19-30p for 16 in the supermarket and 35p on prescription. However, consultation and dispensing costs are considerable.

The spend on OTC painkillers might therefore be like buying a lottery ticket - they will work really well for some people, and rather less well for others. Either way, the losses are insignificant. If there's a chance that they'll work for you, then it's a small price to pay.

The bigger picture

Nevertheless, non-pharmacological actions (for example, rest, fluids, change in activities) are equally or more helpful than painkillers in many cases. So people should buy, obtain or use their painkillers in a supportive environment. For example, non-branded medicines are nearly as cheap in pharmacies as supermarkets, and your pharmacist should be able to talk you through the options and offer other advice, too. Doctors, meanwhile, need more time to explore problems with patients and shouldn't need to write prescriptions to signal the end of a consultation. Their time could be better spent.

Imagine there was enough evidence to ban the OTC sale and prescription supply of simple painkillers. The supply of tea and sympathy would certainly have to increase. It is likely that the demand for compound pain killers or untested treatments would also increase, which risks more serious harm. There would also likely be an increase in visits to the doctor.

A goal to reduce the use of ineffective medicines is desirable. But we must also consider the alternatives and consequences. The treatment of pain isn't the only area of clinical practice where hope is maximised over effectiveness. Improving the safety and effectiveness of chronic pain relief is a higher priority than reducing acute painkiller consumption. For now, people will keep using cheap (perhaps even quite expensive) OTC painkillers - and it's hard to say they're acting irrationally.

The ConversationJonathan Silcock, Senior Lecturer in Pharmacy Practice, University of Bradford

This article was originally published on The Conversation. Read the original article.

>>>>> Scroll down to view and make comments <<<<<<

Click here for Historical News Post Listing

Make a Comment

Econintersect wants your comments, data and opinion on the articles posted. You can also comment using Facebook directly using he comment block below.

Econintersect Contributors

Print this page or create a PDF file of this page
Print Friendly and PDF

The growing use of ad blocking software is creating a shortfall in covering our fixed expenses. Please consider a donation to Econintersect to allow continuing output of quality and balanced financial and economic news and analysis.

Keep up with economic news using our dynamic economic newspapers with the largest international coverage on the internet
Asia / Pacific
Middle East / Africa
USA Government

 navigate econintersect .com


Analysis Blog
News Blog
Investing Blog
Opinion Blog
Precious Metals Blog
Markets Blog
Video of the Day


Asia / Pacific
Middle East / Africa
USA Government

RSS Feeds / Social Media

Combined Econintersect Feed

Free Newsletter

Marketplace - Books & More

Economic Forecast

Content Contribution



  Top Economics Site Contributor TalkMarkets Contributor Finance Blogs Free PageRank Checker Active Search Results Google+

This Web Page by Steven Hansen ---- Copyright 2010 - 2018 Econintersect LLC - all rights reserved