Trending Now: Nontraditional Modalities in OTC Pain Relief

Joe Kiely, PhD
Search & Evaluation, Pain

Until relatively recently, the Western medicine armamentarium for over-the-counter (OTC) pain relief consisted solely of active pharmaceutical ingredients, with varying scientific and clinical credentials, that are used orally or topically. These include well-known products such as nonsteroidal anti-inflammatories, acetaminophen/paracetamol and sometimes these ingredients in combination or with adjuvants such as caffeine. These are highly successful solutions for pain conditions that do not require a visit to a doctor. Nonetheless, there is a cohort of people out there who are uncomfortable with the routine ingestion of 'drugs' or with the addition of yet another pill to the many they are already taking. This drive may be tied to a belief that 'drugs' are harmful to themselves (or to their baby in the case of pregnancy) or even a desire to identify more natural ways to treat their pain. What options do these consumers have? Let’s look at a few examples.

 

Current Options in Nonmedicinal OTC Pain Relief

 

The simple expedients of weight and movement seem to be important for managing pain. Many of us carry some extra ballast on our frames, and it seems sensible that dropping a few pounds will subject our weight-bearing joints to less stress and pain. While nutrition can effect pain relief indirectly (ie, sustained negative energy balance leads to weight loss), there is scant evidence that ingesting specific nutrients leads to pain relief. This is the current state of the science despite the broad literature containing suggestions that, for example, orally ingested magnesium and riboflavin (vitamin B2) supplements may help in migraine prevention. There is fairly good evidence that certain chronic painful conditions, like knee and hip osteoarthritis, respond fairly well to simple exercise and particularly well (knee OA) to those exercise regimens that strengthen the muscle groups that control the knee. Similarly, specific exercise programs have been found to bring relief to neck pain.


Heat and cold (usually ice) are also used to address joint and muscle discomfort, and this is an interesting area for GSK Consumer Healthcare provided it is explored with the scientific method and results in solutions that are demonstrably beneficial for consumers. While there are some 'go-to' regimens such as rest, ice, compression and elevation (or RICE) mentioned in the literature, as far as I’m aware, there isn’t robust scientific literature that quantitatively ties heat energy (Joules) as a function of tissue depth/trauma with discrete measures of pain relief or inflammation reduction.


Transcutaneous electrical nerve stimulation (TENS) devices have also gained more prominence in recent years, and a quick search on Amazon reveals many options for treating lower back pain, general pain relief, migraine or period pain. Some of these TENS devices are nonspecific, targeting a central pain inhibition system (descending pain pathway), and some target specific nerve pathways (cranial nerves or high spinal nerves). These are certainly interesting and may be useful tools for those who wish to try nonmedicinal approaches, although it does feel like there is ample room to enhance the quality of the scientific and clinical support for some of these technologies. Even improvements in form factor would be beneficial since some of these devices can be a little prominent and indiscrete.


There are many other modalities that are employed to help treat or prevent pain and inflammation, and some examples include magnetic methods, yoga, relaxation techniques, hypnosis, cognitive behavioural therapy and even the more recent use of augmented reality and virtual reality. In late 2016, I saw an interesting report describing the use of an augmented reality solution to reduce phantom limb pain—very exciting indeed and potentially a tremendous solution for patients and consumers in the future.

 

Pain Relief Opportunities and GSK Consumer Healthcare

 

We’re always looking for new product ideas for OTC categories. When looking at any potential pain relief opportunity for GSK Consumer Healthcare, we first start with the quality of the evidence underpinning the opportunity. We are interested in bringing nontraditional pain relief solutions to consumers provided they have a solid scientific basis and support. This is key.

 

Our usual touch points for preclinical opportunities are a solid technical rationale and supporting evidence. For example, if you represent that you have a formulation technology that significantly improves the efficacy of (or brings some other benefit to) one of our active pharmaceutical ingredients, we will ask to see data and also a coherent explanation of the science. 

 

If you have an opportunity with clinical data, our usual touch point is the randomized, double-blind, placebo-sham controlled study that is properly powered statistically.  Rather than being dogmatic about these requirements, however, prospective partners should know that we are very receptive to hearing from you, even if you have an incomplete data set—provided that we can both agree there is a pathway to a properly verified solution that will bring benefit to the consumer suffering pain.

 

GSK Consumer Healthcare is always interested in discussing science-based new product ideas for OTC categories.