With pain statistics reaching epidemic proportions, retailers offer products that deliver much-needed relief as well as invaluable counsel.
Pain is a powerful motivator.When we are comfortable, we don’t think of doing anything differently. But Dr. Frank King, founder and president of North Carolina-based King Bio, describes pain as “the alarm we can’t ignore and it tells us something is wrong. It’s a wake-up call to get us to look at what’s going on, and it’s a callto- action that motivates us to change.”
Pain affects more Americans than diabetes, heart disease and cancer combined, according to the National Institutes of Health (see chart).1 An increase in pain prevalence has been recorded for some types of pain in the U. S. population,2 and chronic pain rates are likely to continue to rise.
In fact, according to an ABCNews/USA Today/Stanford University Medical Center poll, more than half of Americans suffer from chronic or recurrent pain, and nearly Half (46 percent) of poll takers reported pain in the last two weeks. After hearing the descriptions, recurrent pain was cited by 34 percent of polltakers, and nearly one in five (19 percent) said they had chronic pain. Forty-four percent said their pain was acute.
Additionally, arthritis has grown at an alarming rate, and doctors diagnose some 50.6 million U.S. adults as having some form of the disease. And according to the Mayo Clinic, approximately 80 percent of all Americans will have low back pain at least once in their lives.Back pain is a common reason for absence from work or visiting the doctor.
For many, their initial reaction to pain is to reach for over-the-counter (OTC) non-steroidal anti-inflammatory medications (NSAIDS). But as commonplace as this solution may have become, the dangers of overusing NSAIDS is also widely publicized, with outlets like WebMD reporting that more than 100,000 people in the U.S. are hospitalized because of NSAID-related problems.3
While pain is reaching epidemic proportions, Ronit Arginteanu, Esq., of counsel at New Jersey-based Ateevia, which produces holistic natural skin treatment products, cited a report from the Institute of Medicine (IOM) highlighting the flaw in how pain is approached in the United States. The report showed that more than 100 million Americans suffer from chronic pain at a cost of around $600 billion a year in medical treatments and lost productivity.“An IOM committee commissioned by Congress concluded that pain is not optimally managed in the U. S. and that effective treatment of chronic pain will require a coordinated national effort to transform how the public, policy makers and health care providers view the condition,” said Arginteanu. “Committee Chair Phillip Pizzo, MD, of Stanford University School of Medicine, said, ‘We see that for many patients chronic pain becomes a disease in its own right. We need to address this in a more comprehensive and interdisciplinary way and include prevention as a very important goal.’”
The primary categories for pain relief, whether it’s OTC medications or supplements and natural products, include back, head, joint/arthritis, muscle, PMS/cramps, nighttime leg cramps and sinus. According to Barbara Apps, business development brand manager with California-based Rainbow Light Nutritional Systems, the supplement pain relief category is trending similar to the OTC pain relief category, with more condition-specific and niche products broken down by type of pain. “Consumers are seeking a more personalized and specialized approach to pain management, whether it’s chronic (i.e., back, joint) or short-term (i.e., headache, PMS/cramps),” she said. But while the two might be correspondingly trending, “overall, OTC and prescription category growth has been flat with 2 percent and 4 percent growth, respectively, versus supplement growth, which is four times and two times the growth (7 percent), according to Nutrition Business Journal numbers.”
Meanwhile, the market for topical pain management products has been increasing over the past several years.Ateevia’s Arginteanu referred to Illinoisbased Nielsen Co., which reported that sales of these remedies topped $313 million in 2012. “While this figure pales when compared with the $2.3 billion sales ticket for internal analgesics, many consumers are starting to curtail their pill-popping ways and have migrated to topical pain management, especially for muscle strains and bruises,” he said, noting that sales of internal analgesics are down 3.1 percent, while external products have grown 2.6 percent.
“Likewise, the market for natural pain relief with stronger safety profiles is on the rise, with an estimated 8 to 10 percent annual growth within the natural holistic pain industry every year for the past five years.”
Further, Apps noted that SPINS data for 2010-11 showed the Pain and Inflammation category grew 35.6 percent.“Helping the category has been the ability to make claims about pain/inflammation for supplements within DSHEA (Dieteary Supplement Health and Education Act)—as long as it is limited in scope and qualified (previously, only homeopathic natural products could make pain claims),” she said.“Inflammation/pain is either a symptom of or a part of nearly every degenerative disease, and minimizing pain [for aging adults] is going to lead to a much better quality of life.”
The Root of Pain
Chronic pain can be caused by many different factors. Often conditions that accompany normal aging may affect bones and joints in ways that cause chronic pain, yet this older demographic is doing anything but retire quietly.
“The number of older Americans participating in sports and active lifestyles has increased by nearly 60 percent since 1990. This over-50 Baby Boomer generation is ‘hell bent’ on Maintaining their exercise routine for life,” said Rainbow Light’s Apps, who also noted that the number of knee replacements in Americans aged 45 to 64 more than tripled between 1997 and 2009, according to the U.S. Agency for Healthcare Research and Quality.
“The fact that the ’60s Woodstock generation is now in their sixties is a driving force in the increased demand in the pain category. Along with all the back, muscle and joint pains typically associated with aging, the elder population also undergoes more surgical procedures,” said King Bio’s King, adding that homeopathic ingredients, most famously Arnica montana, are extremely effective for promoting healing and reducing the pain, swelling and bruising following surgery.
Yet while older shoppers are staying more active than ever, the overall sedentary nature of the U.S. population often results in more injuries when people do engage in recreation or strenuous activities. Add to that an obesity epidemic that puts excess weight and strain on joints, and it’s easy to see why so many are seeking pain relief.
But it’s generally agreed upon that the core culprit of pain is inflammation.
“Inflammation is a main topic of conversation in health circles as the cause of pain,” said David Gerhardt, DcoHom, King Bio’s executive vice president.“Determining the cause of the inflammation goes back a step further, and theories range from stress to imbalanced pH levels caused by poor dietary choices, to microbes and fungus.”
Inflammation is certainly something more customers are coming to Carol Blair, wellness educator, BS, DiHom, CNC, with Natur-Tyme in DeWitt, NY, to ask about, as she’s seen interest in the single store’s pain category grow.
“This has become an important category for us. We have a very educated clientele who have come to realize that Inflammation is associated with pain and that everything, even cancer, begins with inflammation,” she said, adding that the 15,000-square-foot store carries a few hundred pain relief products, including Terry Naturally’s Curcumin and Traumeel by Heel USA. “Arthritis is by far the biggest concern, followed by injuries. We get a lot of interest about natural anti-inflammatory/pain relievers that eliminate the need to resort to OTC and prescription drugs.”
One of the biggest trends driving the consumer to natural choices for their health care is the Internet, according to Mary Jo Mahoney, CoHC, King Bio’s Eastern regional sales manager.“Everyone can now research the potential negative side effects of the medicines that, 20 years ago, they would have been swallowed down without a thought. Now, everyone can see the long list of potential negative side effects that scrolls down after a drug commercial,” she said. “They know to check things out online beforehand, and they are often alarmed by what they see. Consumers are demanding safer options.”
But as actively as consumers are researching their options, they continue to seek the advice of retailers when it comes to making a decision about what to take. Laurel Sterling, MA, RD, CDN, Natur-Tyme’s integrative dietician and wellness educator, said that she’s observed more customers coming in asking about items such as ginger, turmeric, arnica and fish oils to assist them with pain relief. “I have found that most come in based on their own research, while some come in based off a doctor’s recommendation.Typically, they tell me what they know and have read, then we discuss what would be the best option for their specific circumstance.”
And it’s a good thing customers feel comfortable talking with the wellness Team at Natur-Tyme. According to Blair, the recent publicity over the fish oil/prostate cancer “study” was a real problem for one of her customers.
“One customer stopped taking his fish oil after hearing the news and called me up because he was suddenly experiencing a lot more pain,” she recalled.“After I explained this study’s methodology and reviewed several other studies with the customer, he decided to go back on his fish oil with good results.”
Such is the case with consumers turning away from OTC NSAIDS and seeking more natural solutions to their pain issues.
“The COX pathways (COX-1 and COX-2) normally stay in balance, unless there is an injury, trauma or chronic inflammation. The OTC NSAIDS inhibit both COX-1 and COX-2 pathways, reducing pain and inflammation. The problem with NSAIDS is that with prolonged use, and prolonged inhibition of COX-1 pathway, it leaves the body at high risk for gut erosion, gastritis and ulcers, also liver toxicity,” said Michele McRae, CN, Rainbow Light’s senior director of research, formulation and quality.
Realizing how important it is to leave the COX protective pathway intact, Rainbow Light created TheraMend COX-2 Flex, offering a natural pain and inflammation remedy. With this product, the company is capitalizing on another trend: using branded ingredients. The formula includes ingredients like Apresflex branded boswellia and Perluxan branded hops plus curcumin (Meriva), all of which have published clinical trials showing their effective delivery of pain relief.
“Raw material developers have invested time and resources into clinical trials as well as advertising, which helps increase awareness in consumers as to what benefits a particular ingredient may offer,” said Apps. “In the past, it was difficult for consumers to decipher the properties or actions of a particular herb, given the different common names that might be used, and also the varying extract potencies that might be in a product compared to what was shown to be effective. Product labels that include branded ingredients ensure that the same compound used in a clinical trial is in that particular formula for consistent potency and efficacy.”
While it isn’t utilizing branded ingredients, Ateevia also formulated its topical remedy, PRIME, with the purpose of tackling inflammation. The pain relief cream has been in research and development for 20 years, and just launched in the fall of 2012.
“We use natural botanical extracts of pumpkin, poke root, borage, sunflower and safflower. They all contain biologically active natural product compounds with essential anti-inflammatory nutrients that suppress the molecules that cause inflammation in joints and other tissues,” said Arginteanu.
Based on strong feedback, the company is working on expanding its line with a similar formula specifically for athletes called Ateevia ACT.
A Homeopathic Approach
Jessly Raj, senior product brand manager with New Mexicobased Heel, Inc., cited SPINS data showing that the pain management category is the No. 1 category in the homeopathic market, contributing $13 million with 10 percent category growth. She also pointed out that there is tremendous opportunity for and acceptance of the homeopathic market as more consumers and practitioners are looking for safer alternatives to traditional medicines.
“Due to the risk associated with OTC pain relief products, complementary and alternative medicines (CAM) are becoming more popular. In fact, nearly 40 percent of adults report using CAM.4 Physicians are also embracing CAM therapy, often combining them with traditional therapy, which is called integrative medicine,” said Raj.
“Regardless of the therapy used, homeopathy can complement it and enhance the healing process,” added King Bio’s Gerhardt. “In more than 200 years, homeopathic medicine, when prepared by HPUS (Homeopathic Pharmacopoeia of the United States) standards, has shown no contraindications, no known negative side effects and no known negative drug interactions.”
King Bio offers a homeopathic, tastefree, pure water base, oral spray formula called Advanced Arnica. A top seller for the company, it provides relief for generalized pain. “Since homeopathy utilizes the bioenergetic pathways of the nervous system and bypasses the biochemical, digestive process, our spray delivery is easy to use and offers fast relief,” said Gerhardt. A topical version has also been introduced to meet consumer demand.
King added that the company uses multiple homeopathic ingredients in multiple high potencies. “For example, our Advanced Arnica formula includes two variations of arnica in five different potencies. I feel this synergy offers broad-spectrum results,” he said.
Also utilizing multiple components, Heel’s Traumeel topical product is a combination of 12 natural active ingredients (out of 14 actives) that work together, complementing the body’s natural processes to temporarily reduce minor joint, back and muscle pain. Raj explained that it is designed to work without going through the digestive system and has not been associated with the type of side effects linked to typical NSAID use. “Heel’s medicines are easy to use and gently activate the body’s self-healing powers—as intended by nature. Traumeel offers a pain relief product that is safe to use for more than 10 days, and its effectiveness was verified in two double-blind, randomized controlled studies, and in a clinical study (TAASS) in Spain.”
Further, for flexibility of use and to maximize the convenience, Traumeel is available in several dosage forms including: Traumeel 50 g ointment, Traumeel 100 g ointment, Traumeel 50 g gel, Traumeel 250 g gel, Traumeel oral drops 50 ml, Traumeel 100-ct.Tablets and Traumeel combo pack (ointment + tablets).
Bobbi Elliott, owner and operator of Healthy By Nature in Leesburg, VA, expressed that the pain category is easy to manage if one carries quality products.“We always offer a good, better, best choice for our customers. Quality products work … if a customer gets results, they will come back and tell others about it as well.”
And talk they do, or they’re quick to provide comments for the testimonial book Healthy By Nature has on hand.“The best form of advertising is word of mouth,” Elliott continued. “Nine out of 10 customers come to the store seeking relief from some form of arthritis, but once their initial pain is gone, they see relief from other indications, like heartburn or depression. Our customers are thrilled when their initial pain is gone, and as they continue to take it, realize they’re getting other side benefits from it.”
Elliott credits her suppliers for not only providing quality products, but also their support, which she incorporates into the store’s education program.“We offer monthly seminars and have had wonderful speakers—Christopher Hobbs from Rainbow Light, Michael Murray with Natural Factors and EuroPharma’s Terry Lemerond, to name a few. In addition, we have Cds, literature and a reference library. If studies have been done, we have access to them as well,” she said. “Our vendors know that an educated customer is the best customer to have.”
One area where Rainbow Light is helping its retailer partners like Healthy By Nature is navigating claims.
“DSHEA-allowed claims can be difficult to interpret because they aren’t always direct and they don’t always help consumers understand complicated ingredients in a simplistic way,” offered Apps. “That’s why we provide staff training and lectures, including lectures with Dr. Christopher Hobbs, who formulated TheraMend, as well as expanding web-based training to support retailers. Since our products are formulated by a team of clinical experts, we have extensive research and educational materials to support our retail partners, and on-shelf and online coupons to encourage trial.”
Heel USA also provides merchandising support for retailers including staff training, in-store flyers and information on the safety profile of Traumeel in comparison to competitors, which in turn allows retailers to provide safe alternatives to traditional pain medications.
Further, the company recognizes that the homeopathic/natural medicine market is overcrowded. It’s combating this by offering redesigned packaging with a smaller footprint.
“The redesigned Traumeel packaging, with a new vertical orientation, better maximizes shelf space for retailers by taking up less space on the largest-selling items (50 g ointment and gel, and the 100 g ointment), and allowing retailers dramatic profitability gains per foot of shelf space,” said Raj, Noting that these changes are set to debut on store shelves beginning in September, 2014.
When it comes to shelf space and placement, King Bio’s Gerhardt urges retailers to market homeopathic medicine within the structure/function shelves, not segregated into a “homeopathic section.” “We have seen sales soar when consumers have all their pain choices, for example, in one area. They don’t want to see their nutritional and herbal choices in one section and then have to compare their choices in another homeopathic section,” he said.
Beyond offering trainings, in-store consumer lectures, merchandising support, brochures and social media shout-outs for stores, King Bio also offers educational seminars in its hometown, Asheville, N.C., every year.Gerhardt noted that the company is planning an exciting “education-vacation” event for next year.
Ateevia’s Arginteanu offered that promoting a holistic approach to pain relief goes a long way to meeting customers’ needs. But promotion is key.
“Signage and in-store promotion are musts to help educate the consumer.Retailers can also put these products in their circulars (whether on special or not) as a way of building top-of-mind awareness,” he said. “Top-of-mind awareness is crucial in this category, since it's necessity more than price that drives shoppers to purchase these products.
“Retailers need to focus on the needs of their customers by understanding that there should be a holistic, long-term approach to pain management,” Arginteanu concluded.“We need to think preventatively, not reactively; think in terms of pain defense systems, not short-term pain relief.”
1 National Institutes of Health Fact Sheet, Pain Management http://report.nih.gov/NIHfactsheets/ ViewFactSheet.aspx?csid=57.
2 Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011.
3 www.webmd.com/painmanagement/ news/20040123/fda-warns-otc-pain-reliever- misuse, www.fda.gov/ohrms/dockets/ac/02/briefing/ 3882B2_02_McNeil-NSAID.htm.
4 www.mayoclinic.com/health/alternativemedicine/ PN00001.