/ Health, Shopping

Are targeted painkillers a waste of money?

Have you ever bought targeted painkillers for migraine, period or muscle pain? If you have, you might have bought the same product three times over…

The Australian Federal Court has ordered the manufacturers of best-selling painkiller Nurofen to remove its targeted range of painkillers from Australian shops.

The fast-acting Nurofen painkillers (ibuprofen lysine) for ailments such as period pain, migraine and tension headache contained exactly the same product, but were packaged differently.

Targeted painkillers

We don’t have those exact products in the UK, but our own investigations have found similar goings on. You might think that Nurofen Migraine Pain and Nurofen Tension Headache caplets would target your migraine or tension headaches respectively, but you’d be wrong. Ibuprofen can’t target pain in specific body parts.

Nurofen Migraine Pain and Nurofen Tension Headache are exactly the same as each other. They’re also identical to Nurofen Express caplets (available until recently), which can be as much as 2p cheaper per caplet.

Nurofen defends the sale of targeted painkillers, saying that they can help consumers choose the right one.

Generic painkillers

Shopping around can also pay dividends, as well as careful scrutiny of the packaging. Most leading pharmacies and supermarkets also sell generic versions of fast-acting ibuprofen, at as little as a third of the cost per tablet of Nurofen. They’re not identical to the Nurofen tablets, but they do contain the same active ingredients (342mg ibuprofen lysine).

We found 14 products that are all identical to each other, ranging from 8p a tablet at Wilko to 20p per tablet at Boots and Superdrug. They are variously sold as ‘migraine relief’, ‘period pain relief’, ‘express pain relief’ and ‘rapid pain relief, but are actually made at the same production site (labs) to exactly the same formulation.

If you examine the fine print, you’ll find all these products carry the same marketing product licence number. This means that they’re the same, but the licence allows them to be sold under different names.

So you can ignore targeted marketing if you’re clear you’re taking the right ingredient and dose. For example, a man taking Feminax Express – marketed for period pain – will simply be getting 342mg of ibuprofen lysine!

I’ll leave you with one interesting nugget though – there’s a big placebo effect when it comes to medicines. The higher the cost of the painkiller you take and the nicer the packaging, the better the product works on people who take it, even when we know we’re taking a placebo.

Do you agree that we don’t need to buy targeted painkillers? Do you always buy generic and cheap painkillers?

Useful links

The health products you don’t need


Here is a document giving advice on the labelling and packaging of medicines: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/474366/Best_practice_guidance_labelling_and_packaging_of_medicines.pdf

Section 7.3 refers to a code of practice, and there is some sensible advice to keep the marketing people in check regarding their claims. Unfortunately there seems to be no reference to the issue of the need to avoid making false claims about targeting of action of oral drugs – the subject of this Conversation.

Perhaps an update is needed.

Oops! Should read “avoid all pills containing it!”

Wavechange, you may notice a difference if you decided to leave it off, but no need to if it doesn’t bother you. I have friends and relatives that also thrive on it which only demonstrates everyone’s uniqueness. It’s a different matter of course when caffeine is put into generic meds.

I see it as important that people are aware that some over-the-counter medicines contain caffeine, but if drinking coffee, tea and some soft drinks can provide caffeine, then maybe that’s a better way of giving the customer the choice.

Good point Wavechange, a less expensive standard generic pill swallowed down with a cup of caffeinated whatever you prefer could save you quite a bit.

Still haven’t worked out how you manage to sleep after drinking caffeinated coffee though!

I hope that inclusion of caffeine in medicines does not encourage their use to obtain the stimulatory effect.

My coffee intake is a habit rather than an dependence. I’ve drunk decaffeinated coffee for a week and not really noticed much difference. I’m not going to lose sleep about why drinking it does not keep me awake. 🙂

Apologies for veering a bit off topic but at last I may have shed some light on it……..

YouTube.com – Scientists agree: Coffee Naps Are Better Than Coffee Or Naps Alone.

Interesting stuff, definitely not what the title implies 🙂

There is no such thing as a targeted painkiller. They are distributed randomly throughout the body by the bloodstream and only a small percentage of the painkiller acts on the pain. A fair proportion is destroyed as it passes through the body.
There are only really 3 painkillers on the market that can be bought almost anywhere; aspirin,paracetamol and ibuprofen. Virtually all proprietary painkillers are a combination of one or two of these with,sometimes ,caffeine. Add on a trade name and the price over generic painkillers doubles and trebles. Add on a target such as migraine or period pain and price goes up again. The moral is take the GENERIC (unbranded) painkiller which suits you. Forget the drug company hype and save money

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enteeen says:
19 December 2015

Which? has been critical of Nurofen products packaged according to the type of pain. In the magazine article it was pointed out how numerous are the products aimed at relieving pain and I doubt if many people would care to spend a significant amount of their time studying the detailed printing on so many packages to identify those that claim to relieve their particular discomfort. Therefore, I welcome a package that highlights ‘loudly’, the specific area of pain relief I need. It matters to me not a bit, that the same formula is contained in another packet marked for relief of pain elsewhere in the body. The point is that this type of packaging helps to locate the remedy you are looking for.

What is most certainly wrong with this new marketing strategy is the variation in pricng of essentially the same product according to the type of pain. It may be interesting to compare the proportions of Nurofen sales for each of the ‘designated’ pain locations, with their prices – have the manufacturer and/or retailers taken advantage of known or expected demands for pain relief for different symptoms in order to increase their margins?

Notwithstanding the above, the pricing seems to my mind, grossly unfair to consumers. Why should I pay more, or less, to relieve my headache than someone using the same product for back pain? Is this not an issue deserving the attention the appropriate consumer protection authority?

Ibuprofen is sold without prescription as pills containing 200 mg ibuprofen. The versions containing a dose of 342 mg are ibuprofen lysine rather than ibuprofen. They still contain 200 mg ibuprofen but the extra weight is made up of the amino acid lysine. It is incorporated to make the drug more soluble, so it will act faster but presumably for a shorter time.

The important point is not to believe that the 342 mg dose contains more ibuprofen than the 200 mg version.

Before this issue is forgotten about, let’s give some thought to what happens next. Here is a newspaper article that might be worth looking at: http://www.theguardian.com/business/2015/dec/14/nurofens-maker-admits-misleading-consumers-over-contents-in-painkillers

Legal action has been taken in Australia against the manufacturer of Nurofen over products that are claimed to offer targeted pain relief. In the UK, no action is being taken by the regulator, MHRA. From the Guardian article: “Aomesh Bhatt, head of regulatory and medical affairs for Reckitt Benckiser in Europe, said the company did not set out to mislead consumers and was cooperating with the ACCC and the federal court. It was, he said, an “Australia-only issue” with no implications for UK sales.” Why are there no implications for UK sales unless this is because they know that the UK is not likely to take any action.

The article claims: “The Consumers’ Association in the UK said it had no comment to make as it had not looked at the issue.” That’s surprising because Which? had produced an article on the topic for the Which? magazine.

Which? has done a great job in alerting us to consumer problems, but usually I am left wondering whether or not further action is going to be taken. I appreciate that some issues are outside the remit of Which? and others be difficult or costly to pursue, but it would be a courtesy to let us know which issues will (or might) be pursued and which will not.

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Since the Advertising Standards Association is looking into complaints about Nurofen product marketing, there may be no need for further action by Which? Why not tell us if this is the case?

The ASA seems to do a good job, but companies are able to profit from false claims before being told to withdraw advertising.

Political issues need not be political if you adopt the approach that a task must be done irrespective of which party is in power. That’s my outlook.

What if research showed that there was a genuine placebo effect – that the same basic drug but sold as a target painkiller actually appeared to give better or quicker relief then the plain drug?
I remember seeing a program on tv (so it must be true) that rub-in painkillers like Voltarol sold as getting inside the body to the pain source do, in practice, do no such thing. Is there any evidence of their efficacy? If not should they not be withdrawn and their misleading (is it fraudulent) advertising banned?

The placebo effect is very well established and it is likely that users that believe in targeted products will find them more effective than exactly the same drugs that do not come with the claim. Nevertheless, it is ‘misleading advertising’ to suggest that pain relief can be targeted by an oral medicine.

Diclofenac is a more powerful non-steroidal anti-inflammatory than ibuprofen and is best avoided by many people, including those with stomach problems. Like many chemicals it will pass through the skin. I have long had my doubts how effective it would be to treat an arthritic knee, since the source of pain is well away from the skin. BNF states: “The evidence does not support the use of topical rubefacients in acute or chronic musculoskeletal pain.” There is no doubt that Voltarol gel and similar products offer topical treatment but the question here is whether they are effective. Unfortunately, it’s not a topic that Sense about Science has looked at.

“Nevertheless, it is ‘misleading advertising’ to suggest that pain relief can be targeted by an oral medicine.”. An interesting dilemma. If I believe a targeted drug helps my back ache – and if it does it better than the base drug – because of the way it is promoted is that bad? If, by banning the promotion, many people are no longer helped by the placebo effect, is that bad? I think I’d prefer to have my back ache helped. But do we put “principles” before outcome – does the end sometimes justify the means?

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The likely infringements would relate to ‘misleading advertising’ and (lack of) ‘substantiation’ in the refreshingly simple terminology used by the ASA. I see your point but I strongly believe that there is already far too much misrepresentation in advertising.

It’s an interesting question and I will see what friends in the medical profession have to say.

That’s a bit different, Duncan. I agree that your drug is targeted, and so is the salbutamol many of us use for asthma. What we are referring to here is exactly the same drug being marketed for various specific conditions. That’s very different.

Hi Wavechange,

Sorry for the delay in replying to your question. We hope that further legal action will not be necessary. Following the Australian ruling consumers have every right to expect that Reckitt Benckiser will do the right thing, not just in Australia but around the world.

Thanks Lauren, and Happy New Year.

I hope you are right that Reckitt Benckiser will take action worldwide and I look forward to the ‘targeted’ pain relief pills disappearing from the market. Unfortunately, RB will have profited considerably on these sales, which is why I believe it is essential to have claims scrutinised before adverts appear instead of responding to complaints.

Happy New Year to you too!

I guess we’ll have to sit tight and see what follows 🙂

@malcolm-r – I did speak to a friend who had worked in general practice before becoming a consultant, regarding ‘targeted’ medicines, branded vs generic medicines, and the placebo effect. Apparently GPs are under a lot of pressure from the public to prescribe brands that are exactly the same as generic medicines but cost more, in the same way that they push GPs to prescribe antibiotics for colds and flu. Education was the suggested solution.

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Duncan – This discussion is about the marketing of exactly the same product with packaging that suggests it targets a particular problem.

Whether brands and generic drugs are as effective is a different but related issue. Where a drug is out of patent and generic versions are available, the GP or hospital doctor will normally put the British Approved Name (generic name) on a prescription unless they wish to prescribe a particular brand. If you are having a problem with one brand I would expect a specialist or doctor to offer an alternative that does not cause side effects.

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Our local GPs have notices up, and on their websites, informing patients that antibiotics are not effective against colds and flu. So I would be surprised if GPs responded to any pressure to prescribe them (but I can be surprised!).

As far as branded medicines go, like the rest of us GPs are in control, presumably, of how they respond to marketing pressures. If they are bribed into prescribing branded drugs when generic will do perfectly well then that is their responsibility. Maybe the NHS Trusts and the BMA could address the ethics of this? However I do understand that some branded treatments are better than the generic versions?

I am not condoning one drug being sold under different guises as targeting specific ailments but raised the question that if the expectation it would work actually helped the ailment (a placebo effect) we might shoot ourselves in the foot by removing that benefit (if it was shown to be a genuine effect). If there are three differently packaged versions of the same drug, aimed at different ailments, I wonder whether this really matters unless you have period pains, migraines and tension head aches at the same time and are tempted to buy all three versions. Each one, presumably, is effective on the ailment it is sold for?

There’s plenty of evidence of antibiotics being handed out to people with viral infections, and the leaflets you mention have been in use for years. It’s probably worth sticking to considering medicines on open sale since I don’t believe that ‘Nurofen’ in any of its forms sold for use by adults is available on an NHS prescription. A pharmacist could choose to dispense Nurofen if presented with a prescription for ibuprofen, but the price differential is sufficient to make this unlikely.

I see the targeted marketing of the same drugs for different purposes in the same way as a manufacturer selling the same washing machine under different brand names and different prices. It is deliberately misleading the consumer.

Another article with accurate information but lacking the full picture.

Ibuprofen lysine marketed for migraines is actually ok. When you get a migraine, the quicker you can get pain relief, the better you treat the migraine. And the lysine ibuprofen dissolves faster. So if it helps some people decide, good on it.

Trust me, I’m a Pharmacist

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“Trust me I’m a Pharmacist”………one post……….one comment………..been and gone wonder of the day
Yet another talk down to the common man statement…………….Patronised
Who the h*** knows how much pain the sufferer is in…………..
I have not passed much comment on this topic as I’d probably court disaster again but whilst I to date have had no problem with generic medicines unlike Duncan I have had my fill of 500 mg paracetamol that would not cure a fly’s version of my pains……………….When I was young I was given the same medicine twice after the first reaction but I was told it was “unlikely” to be Aspirin…………………I dont believe a b****y word of half these folks
It took a change of health center to a family of Doctors who know their people……………………And I’m not scrounger………………..I’ve done more work than some can dream about
Again I see in the post the “a little knowledge can be dangerous” that a once Doc of mine ran past me or it felt like over me or through me…………
I’d just had the symptoms of a heart attack,,,,,,,,,,,The blue’s and two’s had arrived in the middle of the night because my wife gave the 999 call all the symptoms and that was followed by endless ECGs and so forth………………
Not once during that did anyone suggest a severe panic attack…….not once
I spent the next 8 months recovering on my own without treatment of any kind……………..
I years later met that Doc……….once a high in the BMA about that time…………He said I was way too laid back to have had anxiety……………………Yes FACT……………Nice enough man but his knowledge had went to his head I think…………….
Most experts today will tell you depression is the curse of the strong as titled by Tim Cantopher and the Term The Black Dog was coined by Churchill so we know that outward appearances are usually the opposite of what is beneath…………..
Once I felt I could I got took up another job offer but had I known or had I been advised those years ago the next event years down the line might probably never have happened
So to all you experts out there…………….Just because Duncan or Dee didnt receive a University education does not mean we haven’t our heads screwed on……………….
Personally I have been patronised several times once such swell headed p****s found out my education background…………..It didnt matter that I had availed myself of the education or that it was obvious I knew more than them…………….In they’re eyes I didnt……………..
For people who read and then consider themselves to be able to advise against those with first hand knowledge is to be arrogant
For people with supposed education to suppose they know better or more than those with hands on experience should it be about a pain killer, diesel engine or an orbital sander is to be arrogant.

Those who are wealthy are quite often healthy
Those who are sad are quite often mad (angry)
Those who show empathy are quite full of sympathy
Those who postulate quite often capitulate
Those who are bullies are often unruly
Those who discriminate quite often manipulate
Those who ignore should be flat on the floor
Those who fire bullets,,,,,, they need to cool it.
Those who look down,,,,,upon others are clowns

We always,,,,,,,,,,,,come back to the clowns
DeeKay 2016

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Before embarking on a course of painkillers people should be made aware of the dangers of rebound headaches (See drugs.com – Rebound Headaches.)

Most generic meds will include only scant details (if any at all) of this phenomenon in their package leaflet details. which can occur following frequent use. Which? might consider ensuring pharmaceuticals make it clearer to consumers of the risks involved.