Why Indians Love Their Painkillers, Even at the Cost of Serious Side Effects

NSAID painkillers are widely prescribed because they are largely safe to use. However, the safety come with caveats.

A recent government alert warning of adverse effects linked to the popular pain relief medicine Meftal has caused a stir and once again thrown up the question – Are painkillers safe?

The TL;DR (too long; didn't read) answer to this question is, yes, your run-of-the-mill painkillers (NSAIDs or non-steroidal anti-inflammatory drugs) are pretty safe if taken as prescribed. However, there's more to it.

The bigger question, however, is: Will the prospect of severe side effects and adverse reactions deter Indians from reaching for their trusty painkiller?

Let's break it down.

A Long History of Adverse Affects

Now, while NSAIDs are the most prescribed pain relievers, and are generally thought to be safe. They do, however, come with a long list of possible side effects that are often glossed over.

Speaking to FIT, Dr Dhruv Bibra, Pain Management Specialist at Delhi Pain Management Centre says, "These are drugs that do have side effects, and long-term unsupervised use can cause them to flare up."

Some of the most common side effects linked to prolonged overuse of NSAIDs are:

• Heartburn

• Diarrhea

• Drowsiness

• Allergic reactions

"Painkillers are hard on our stomachs, they are hard on our kidneys, liver. If taken over a long period of time, they can also cause heart issues."

Dr Dhruv Bibra, Pain Management Specialist

In fact, a recent study, published in the Journal of the American College of Cardiology, found that even short-term use of NSAIDs was associated with first-time hospitalisation for heart failure in people with Type 2 diabetes.

Speaking to FIT for a previous article, Dr Gagandeep Singh, Neurologist and Professor at Dayanand Medical College, Ludhiana, says frequent use of NSAIDs to treat headaches can also trigger 'medication overuse headaches'.

"In case of chronic headaches like migraines it happens so that over time NSAIDs could start becoming less effective or increasing the intensity of the pain when the affect of the medicine ebbs."

Dr Gagandeep Singh

This causes a person to double down on the pills, which can further increase headaches.

Meftal isn't the first popular painkiller to be pulled up by drug regulators in India for being linked to possible health risks. However, attempts at restricting these drugs haven't stuck very often.

In 1996, the Indian government banned the combination of painkiller and anti-pyretic drug Analgin with other drugs. The drug, at the time, was used in Baralgan, a brand name combination drug popular in the 80s and 90s, for menstrual cramps.

Later, in 2013 Analgin was banned altogether after mounting evidence of severe side effects including the risk of severe fall in white-blood-cell count linked to the drug from around the world.

While the drug is still banned in many countries including the US, Japan, Australia and France, the ban in India was lifted a year later in 2014.

In the same vein, in 2018 popular over-the-counter pain relief medicine, Saridon along with 327 other fixed-dose combination (FDC) drugs were banned citing safety issues and a 'lack of therapeutic justification'.

However, after a legal tousle, Saridone was exempted from the list by the Supreme Court in 2019.

India and It's OTC Problem

Have the multiple warnings and alerts by doctors, researchers, and drug regulators discouraged the purchase and indiscriminate use of painkillers in India? Not really.

Over-the-counter medicines for symptomatic relied, especially painkillers are extremely popular in India, to the point of certain brand names almost having a cultish following. This, perhaps, has to do with the fact that they are inexpensive, readily available, and for most parts, get the job done.

A report released by Superbrands – a global publishing house on branding – in 2020 said, "The volume of Saridon strips sold in a month when vertically connected end-to-end will soar 324 times higher than Mount Everest."

This is not surprising, considering the same report found that 31 tablets of Saridon is sold in India every second. And this is after the warning of health risks and discouragement by doctors.

Meftal spas is another OTC drug that is nearly venerated by those who experience painful period pain. So much so that the reaction to the news of the drug being flagged was met with vehement denial and even disregard for any possible side effects.

Authorities do try to tackle the OTC problem in small spurts, but, the unregulated sale and purchase of painkillers in India is too big a beast to slay with band-aid solutions.

For instance, even when combination drugs using Analgin were banned, Baralgan continued to be sold over-the-counter, with many merrily purchasing it without even making the connection.

Delhi's Drug Control Authority has tried placing a ban on over-the-counter (OTC) sales of painkillers from Aspirin, Ibuprofen and diclofenac groups multiple times in an attempt to restrict their use. However, for most parts, they continue to be widely available without a prescription.

"This is an unfortunate thing about all painkillers in the market. They are easily available over the counter. And even when they're prescribed, patients go beyond the prescription as well," says Dr Bibra.

How Else Do You Kill the Pain?

Have a pesky headache, have a backache sitting in a bad posture all day, or have a painful injury? You might want to pop a painkiller.

"It's okay to take NSAIDs judiciously, under a doctor's supervision," Dr Anshu Roghatgi, a neurologist at Sir Gangaram Hospital, Delhi has told FIT previously. Most experts agree.

However, Dr Bibra adds, its important to understand that painkillers work likes crutches, not cures.

"I see my patients often pop multiple of them a day, and I tell them, if the first two didn't work, the third isn't going to either. In fact, what you are going to get is the side effects."

"Acute pain is a cause. So what we need to do is find out what is causing the pain. If we keep masking the pain without addressing the cause, over a period of time, it can lead to further complications," says Dr Bibra.

So, while one might need a painkiller now and then to deal with a one off pain or ache, if you're having to pop them regularly to get through your day, its best to get it examined by a specialist.