Are more expensive painkillers worth the money?
With a vast range of painkillers available, and some of them 10 times the price of others, it's hard to know what to choose.
Are the cheap ones as good as expensive brands?
We chose to look at one of the most commonly available painkillers in the UK – ibuprofen - and see whether spending more money meant getting a more effective product. Ibuprofen works by inhibiting our feeling of pain, and since its discovery in the 1960s we’ve been popping ibuprofen pills to kill pain and reduce fever and inflammation.
We selected a range of 200mg oral ibuprofen painkillers – some of them the well-known brands from companies that do the initial drug research and charge higher prices, and some of them the more modestly priced generic products.
The products were sent for laboratory testing to establish two things: firstly, whether each product contained the amount of ibuprofen the package claimed it did, and secondly to see how long it took each product to release the drug (to give an idea of how quickly it might be absorbed into our blood stream to become active).
A HPLC (high performance liquid chromatography) test was used to establish the contents of each tablet, and ALL the products we tested contained ibuprofen in the amounts stated on the packet, give or take 5%. That’s reassuring, and exactly as it should be – because licensed medicines in the UK are tightly regulated by the Medicines and Healthcare products Regulatory Authority, or MHRA. They ensure the quality of the medicines we buy, and wouldn’t grant a licence if a product didn’t meet the claims made on its package – so they help ensure that if a packet promises you 200mg ibuprofen, that’s exactly what you’re going to get.
The second test the labs did was a dissolution test: tablets are dissolved in a solution and the amount of ibuprofen released from the tablet is measured at different time intervals. This test is used throughout the pharmaceutical industry and is an indicator as to how the tablet might behave in the body. It’s NOT a perfect model, but by telling us how quickly the drug is released it gives an indication of how quickly an ingredient might get into our blood stream.
We found that all our tablets – regardless of whether they were branded or generic – dissolved within the British Standard of at least 75% of the active ingredient (in this case ibuprofen) being in solution in 45 minutes.
The standard 200mg tablets generally seemed to release the ibuprofen in a similar way, regardless of whether they were the expensive branded packets or the cheaper generic products. And once again, this is something that the MHRA helps ensure. If a manufacturer wants to develop a generic version of a product, it has to demonstrate to the MHRA that the product is bio-equivalent to the brand leader. That means that the drug which is released from the generic product must reach the blood stream at the same rate as the brand leader’s product.
So much for the standard tablets, but what about products that claimed to be ‘fast acting’ or ‘express’?
We tested some branded and generic “fast-acting” painkillers, and found that they did indeed release the drug quicker than the standard painkillers.
With the fast-acting painkillers, the majority of the ibuprofen was released within 20 minutes, meaning it was being released faster than the standard ibuprofen tablets. However, once again the generic products also hit this same 20 minute target. Again, this is because the claim to be “fast acting” or “express” is tightly regulated in the UK – in order to make this claim, a manufacturer needs to provide the MHRA with evidence that the product does indeed work faster. This is as true for the cheaper, generic fast-acting products as it is for the more expensive branded versions.
There are several ways that painkillers can be made to act faster – the ibuprofen can be held as a liquid in a gel capsule or caplet, or the ibuprofen itself can be contained in a tablet in a salt form: as ibuprofen lysine or ibuprofen sodium, which can be absorbed faster.
Some companies market products as being for specific types of pain such as ‘Joint Pain’, ‘Period Pain’ and ‘Tension Headache’. Is it really possible for manufacturers to create an ibuprofen tablet that is so clever it can target your headache, or back pain, joint pain?
The answer is no – not with oral ibuprofen. Ibuprofen doesn’t target just one of these things, it affects all of them at the same time. That’s because ibuprofen dampens pain wherever it is in the body – so it will help your back pain at the same time as it’s helping your headache or joints. And that’s true of ANY ibuprofen, regardless of price.
In 2015, an Australian court found that one of the leading ibuprofen brands, Nurofen, had misled the public there by marketing four products that claimed to target specific types of pain – back pain, period pain, and headaches – without making it clear that it was exactly the same medicine in each box. The wording on their boxes in the UK is slightly different.
When we approached Nurofen about their “pain specific” range of products, they had this to say:
Nurofen offers more than 10 different registered ibuprofen formulations across our range with different formulations and dosages more appropriate for faster, longer lasting or stronger pain relief, giving consumers a range of choices to meet their requirements. Pain specific products provide easy navigation of pain relief and consumer research indicates that 7 in 10 people say these packs help them decide which product is best for their needs. Any Nurofen products which have the same active ingredient, pack-size, format and formulation have the same manufacturer’s recommended retail price.
But while the 'targeted pain' products may seem to offer choice, it could also be argued that they are leading to more confusion, by suggesting that it is possible for pills to target specific types of pain when this is not the case. Buyers should be aware that ibuprofen works across the body as a whole.
What does all this mean?
The MHRA regulates all medication sold in the UK and so for a generics firm to be granted a licence, they must match the standard of the brand leader, the medicine must contain the same amount of the active ingredients and must interact with the body in the same way. This means that the quality of any tablets sold in the UK is very strictly controlled, and consumers are well-protected.
As our tests have shown, there’s no real benefit to paying more money for a branded product as the generics are legally required to be just as good. Spending more money simply won’t buy you a better quality painkiller.
So if you need pain relief and do choose ibuprofen: if it says ibuprofen on the box then it must be ibuprofen in the box. However, remember that ibuprofen cannot target specific types of pain or areas of the body, so whether you have a headache, back pain or period pain, any ibuprofen product will have exactly the same effect on you.
The fast-acting tablets will dissolve a little faster than most of the standard ibuprofen products, generally releasing their active ingredient around 10-20 minutes more quickly.
If you’re ever in doubt about what to buy, or simply want more advice, ask your pharmacist, as they are there to provide expert advice and can tailor the advice to your needs.