Q&A: What are the Current, Emerging Trends in OTC Pain Management?

The use of medications for treating acute or chronic pain has become a taboo subject in the US as of recent history. Amid a nationwide opioid crisis and the potential rescheduling of drugs like cannabis, the options patients have for treating their pain are vast but not standardized—whether they are prescription drugs or over-the-counter (OTC) products.

In other words, there is a plethora of options for treating pain, but no one option is significantly preferred over others.

“When it comes to the OTCs, the over-the-counter pain management options, we really do have a decent amount of them,” said Mark Garofoli, PharmD, BCGP, CPE. “An individual scenario is going to come down to what a patient has going on, and as health care professionals, we're patients too, so whatever is in our head.”

Mark Garofoli delved into current understandings of the OTC space when it comes to treating pain. | image credit: LukaszDesign / stock.adobe.com

Garofoli, a certified pain expert, recently joined Drug Topics to discuss common trends in OTC medication use for pain as he’s been working in the pharmacy industry since 2001.

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“Most folks, if not all, don't really think about this, but analgesia, where'd that come from?” he continued. “The name just rolls off the tongue now, after [about] a century of experience, but it's derived from Greek to mean ‘without pain.’ So, we literally put out in the aisle a sign that says, ‘Without Pain,’ making that the goal.”

In part 1 of our interview with Garofoli, he delved into current understandings of the OTC space in treating pain. He also discussed emerging OTC options, specifically topicals, that have potential to make waves in the marketplace but are still lacking in efficacy and safety research.

Drug Topics: In your experience as a pharmacist, what are the most common and effective OTC medications that have been used to treat acute pain?

Mark Garofoli: When it comes to the OTCs, the over-the-counter pain management options, we really do have a decent amount of them. An individual scenario is going to come down to what a patient has going on, and as health care professionals, we're patients too, so whatever is in our head. We have those biases based on direct-to-consumer advertising, word of mouth, you name it. Usually we're talking about a pharmacy, but it could also be a grocery store, convenience store, gas station, dollar store, whatever type. [In those places,] we have that analgesics aisle. Most folks, if not all, don't really think about this, but analgesia, where'd that come from? The name just rolls off the tongue now, after [about] a century of experience, but it's derived from Greek to mean “without pain.” So, we literally put out in the aisle a sign that says, “Without Pain,” making that the goal. We have to keep that in mind with folks too. Is that the goal? We certainly want to be compassionate here but is it always the goal is a really good conversation question, of course.

When we're thinking about what people are looking for, it's typically the pill formulations. We have OTC non-steroidal anti-inflammatory drugs (NSAIDs), our most common being ibuprofen, naproxen, and, of course, aspirin in there as well, too. Then [there’s] acetaminophen, or as the entire rest of the world calls it, paracetamol. Good golly, it's like the metric system, but with a pain medicine. We're the only ones. We drive our own truck here in that regard. But those are a lot of the common ones. Topicals: It seems like a new frontier; takes up a lot of the aisles, lots of options out there. And boy, it gets confusing really quick, because it's like, which one, when there's 15 different versions, maybe 10, of each individual product. At least in our society, our culture, it's typically the pill formulations, but our horizons are expanding these days.

Drug Topics: What are the most notable trends you’ve seen in patient preferences for specific over-the-counter pain relief products?

Mark Garofoli: I alluded to the idea of, we typically go to the pill formulations, sometimes liquid as well, too; it depends on the scenario. When our kiddos are in pain or having fevers, oh my goodness, it's like we make it Calc 3 for dosing and we don't even put it on the label. As far as trends overall, you have pill formulations, oral formulations. But then there's a growing trend, and this is observational, don't necessarily have a study, they're out there, but what about topical formulations? It's growing. That being said, are we catching up with the rest of the planet? I mean, when you go to a different continent—not necessarily just outside of our country—it's a very different landscape. The preference, the trends in many other continents would be topical first. Is that right, wrong? It depends on the scenario, of course, too, but we're starting to see some of that shift overall, because there's more education. Yes, there's more marketing out there too, but there's more education as to how to go about pain management when you, I, as the patient, are in charge over the counter.

I think it remains to be said, of course, cannabis and CBD, everything these days, on the tips of everyone's tongue. So topical CBD seems to be a thing. We've had some interesting recent articles with that. Probably one of the most in-our-faces titles and headlines I've seen, a study came out, and literally, the title was like, “Hey, topical CBD, not really working out for pain,” and boy, that catches headlines. It's like the media didn't even have to change the headline; the title was right there. Again, that's one study; there are many others. We have to stop that insanity of going by one study, unless it's quite the profound one. So, those are some of the big-picture trends overall, I'd say.

Stay tuned for more from our conversation with Mark Garofoli, as he further explains OTC medications used for treating pain and the importance of pharmacist counseling among patients using these products.

READ MORE: Pain Management Resource Center

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