Painkillers have logged double-digit growth in the past 2 years; will the rally continue?

For Bharat Bhushan Mehta, an avid tennis and badminton player even at 79, disaster struck during a tennis match about two years ago when the Covid-19 pandemic was on the wane. Attempting a smash, he sprained his shoulder badly. Mehta, who lived for the thrill of the game, tried to ignore the injury, popping pills and consulting some neighbourhood doctors. Nothing eased the pain, but he was not queuing up at hospitals.

Finally, in February 2022, when hospitals had reduced the number of Covid-19 beds and opened their doors to general patients, Mehta consulted a specialist. The diagnosis: Rotator cuff tear. Mehta was soon in hospital for arthroscopic repair surgery and recovered.

Mehta and others like him, who began getting back into physically active life with a vengeance after months of Covid-19 lockdowns and physical distancing, are unwittingly contributing to double-digit growth in sales of pain medications, analgesics, muscle relaxants, over-the-counter (OTC) drugs, and even implants.

Dr Deepak Chaudhary, Senior Director and Head of the Department, Arthroscopy and Sports Medicine at New Delhi’s BLK-Max Super Speciality Hospital, who operated on Mehta, says even minor trauma can cause such muscle tears. The rotator cuff is a group of four muscles on each shoulder joint.

“As individuals age, these muscles can weaken due to wear and tear, and even minor or no trauma can cause tears. Many patients with shoulder pain fail to recognise the seriousness of their condition and resort to self-medication,” says Chaudhary.

It’s not just people getting back to an active life. Many have started lifting weights at home or taking up sports to get fit. Then many had to postpone elective surgeries because hospitals were focussed on the pandemic and were careful about admitting general cases.

The market gains from the pain

Manufacturers of pain management drugs are pumped up and swaggering around, and why not? They are reporting robust double-digit growth in sales over the past two years, even as the size of the market grows.

Their offerings range from pills and sprays to lotions, ointments, and implants. An example is Smith+Nephew’s Regeneten Bioinductive implant, launched in India on July 11 this year. Smith+Nephew reckons rotator cuff injuries in India added up to at least 150,000 cases in 2022, and just 28,000 of these opted for repairs. The company estimates that rotator cuff repair cases will rise to 33,000 in 2023 and 39,000 in 2024, a year-on-year growth of 15 per cent.

“The number of patients requiring such surgeries is increasing as patient awareness and knowledge about shoulder pain improve after the pandemic. For people now more active in sports and gyms, many surgeries could be avoided if patients seek treatment earlier,” says Chaudhary.

As a class, analgesics, or pain relievers, have consistently grown at 4-18 per cent. Analgesics can be OTC or require a prescription. Analgesics as a class rank at No. 7 by sales in the Indian pharmaceuticals market after cardiac medications, anti-infectives, gastrointestinal drugs, diabetes pills, respiratory treatments and even vitamins (not necessarily in that order).

Pharmarack, a technology platform and software solution designed to streamline and digitalise the pharmaceutical supply chain, says the moving annual total (MAT) or the sales data over a rolling 12-month period, was Rs 13,071 crore in April 2023 for painkillers and analgesics. The MAT for April 2019, or just a year before Covid-19 was declared a pandemic, was Rs 8,894 crore.

The MAT for the muscle relaxants segment has grown by 20.75 per cent since 2019, to Rs 355 crore in April 2023 (from Rs 294 crore).

Sheetal Sapale, Vice President-Commercial at Pharmarack AWACS, says the pain market has shown a robust five-year CAGR of 10 per cent.

“Muscle relaxants, local anaesthetics, and anti-inflammatory drugs, which are relevant for sports-related injuries, have also demonstrated promising growth in the same period. This growth comes after a slowdown during the Covid-19 pandemic,” says Sapale.

Going by the CAGR or compounded annual growth rate of companies dominant in the pain market over the past five years, Ipca Laboratories tops, followed by Sun Pharmaceutical Industries Ltd, GlaxoSmithKline Pharmaceuticals (GSK), Zydus Lifesciences and Micro Labs.

Ipca Labs reported a CAGR of 9.4 per cent, and Sun Pharma 8.8 per cent. Ipca’s sales grew by 23 per cent last year, and Sun Pharma’s by 14 per cent. GSK reported a CAGR of 4.3 per cent, followed closely by Zydus with 4.2 per cent and Micro Labs with 3.9 per cent.

The CAGR numbers relate to the painkillers businesses of these companies in the period 2019-2023.

Similarly, for companies like Cipla with a significant pain management portfolio through Cipla Health—a wholly-owned subsidiary of Cipla Ltd—sales in the pain market have shown moderate growth, with a CAGR of 2.1 per cent over the past five years.

Shivam Puri, CEO of Cipla Health, says, “We have witnessed significant growth in demand for pain care products owing to rising cases of body pain due to the pandemic-induced sedentary lifestyle. Our pain management gel, Omnigel, led the growth in this segment by outgrowing the category by 1.2x.”

Puri says that the household penetration of the category has increased, and the company expects the market to grow further as consumers move towards newer ways of treating their pain. “Understanding consumer needs and introducing innovations based on deep-rooted insights will be the key to growing further in this segment,” he adds.

Meanwhile, Dr. Reddy’s Laboratories—another manufacturer of pain management drugs—has shown consistent growth in sales, with a surge of 19 per cent last year, which indicates a positive trend. In February 2022, Dr. Reddy’s entered into an exclusive sales and distribution agreement with Novartis India Ltd for the Voveran painkiller range, Calcium range and Methergine in India.

“Our business in India has consistently driven strong growth and continues to be a significant focus market for us. Through this agreement, we aim to reinforce our portfolio in pain management and women’s health domains,” says M.V. Ramana, CEO–Branded Markets (India & Emerging Markets), Dr. Reddy’s.

According to a company spokesperson, pain management is a core therapeutic area for Dr. Reddy’s. “We have a significant product portfolio in the space. In FY22, we licensed the Voveran range, among other products…. India is a very strong focus area for us. We aspire to break into the Top 5 in India. Pain management will continue to play an important role,” the spokesperson says.

What set off the wave of pain?

After the Covid-19 pandemic’s disruption, people focus more on staying in shape, according to a survey of 700 consumers across 12 cities by Pronto Consult, a consulting firm that works with companies across sectors, including healthcare.

According to the survey, more than 51 per cent of the respondents said health is a priority for them, compared with only 11 per cent in the pre-lockdown era. The study found that chronic pain, muscle injury, post-surgery recovery, and sports-related injuries were the primary reasons for using muscle relaxants.

“The muscle relaxant market in India is experiencing steady growth due to various factors, such as an increase in musculoskeletal disorders, a rising geriatric population, changing lifestyles, and growing awareness of healthcare,” says Karishma Shah, Founder and Managing Partner of Pronto Consult.

The survey found that 83 per cent of consumers felt the motivation to take a pain- or muscle-related drug was to improve their quality of life. The researchers studied the bills and found that topical applications were the most purchased, with Volini being the most bought brand across retail stores.

Hari Natarajan, Founder and Managing Partner at Pronto Consult, says the sports medicine market, driven by medicines that offer quick relief, has been growing at a fast clip.

“The growth of the sports medicine market is driven by several factors, including the increasing prevalence of sports-related injuries, a growing emphasis on physical fitness and sports participation, advancements in sports medicine technology, and a rising awareness of the importance of injury prevention and management in sports,” says Natarajan. He adds that the sports medicine market goes beyond medicines and includes orthopaedic devices, surgical equipment, and performance monitoring devices.

Dr Debashish Chanda, Lead Consultant-Orthopaedics at CK Birla Hospital in Gurugram, says innovative pain management and muscle relaxation combinations are also spurring the market growth.

“Certain companies have even introduced similar products under multiple brand names, recognising the immense potential of this market. This upward trend in demand for such medications can be attributed to various factors, with one notable influence being the post-Covid-19 era,” says Chanda.

The orthopaedic surgeon says that many people, locked indoors by the Covid-19 shutdown, took advice from physical fitness experts and self-proclaimed experts on YouTube and Facebook. Injuries became common because people tried out exercises without the physical presence of coaches. “Consequently, both topical application creams and oral medications experienced a significant rise in sales,” says Chanda.

The pharmaceuticals industry has responded quickly, introducing many new molecules and drug combinations for topical and oral medications and expanding patient treatment choices.

Chanda believes that the market growth is much greater than what is visible. “Many patients purchase over-the-counter medicines without consulting doctors, as the market demand has become so vast that it overwhelms the healthcare system. As a result, the actual number of patients seeking medical attention may be underestimated,” he says.

And it is not just the exercise craze leading to more pain.

Those not caught by the exercise bug are probably glued for hours to their smartphones or laptops, playing computer games or just hooked to social media. Sitting or lying for long periods is bad for your back or hips.

“The growth in the pain management and muscle relaxant market is undeniable and continues to show immense potential. We may only be seeing the tip of the iceberg, as this upward trajectory is projected to continue in the foreseeable future, redefining the landscape of healthcare and patient well-being,” says Chanda. 

@neetu_csharma