key: cord-1046994-aqy7gc9c
authors: Do, Thien Phu; Do, Hien Quoc
title: Internet Search Interest for Over-The-Counter Analgesics during the COVID-19 Pandemic
date: 2020-11-19
journal: Pain Med
DOI: 10.1093/pm/pnaa434
sha: 8bcd716e9040ec6c59355800dcd5c8d61c70c518
doc_id: 1046994
cord_uid: aqy7gc9c

nan

The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 is an ongoing pandemic with a major impact on healthcare services. The phenomenon of consumer panic and stockpiling of goods, so-called "hoarding", has previously been described during public crises. A common explanation for this phenomenon is that stockpiling enables consumers a sense of control during a crisis. Increased grocery spending during the COVID-19 pandemic has already been reported for packaged necessities such as toilet paper, rice and pasta, but has not previously been investigated for over-the-counter (OTC) analgesics. To better understand the scope of interest and potential demand for pain relief during the COVID-19 pandemic, we examined internet searches for common OTC analgesics (i.e. ibuprofen, acetaminophen, naproxen and aspirin) in the United States.

Google Trends (https://trends.google.com/) tracks and provides rankings for past search queries from 2004 and onwards. Search terms are ranked relative to the total volume of searches performed and is quantified by the Relative Search Volume (RSV). The RSV ranges from 0-100, where highest interest of a search query in a given time period is quantified as 100 RSV and least interest as 0 RSV. We extracted the RSV of Google searches originating from the United States with the terms: "ibuprofen", "acetaminophen", "naproxen" and "aspirin", in the time period September 1, 2017 to August 31, 2020 to account for potential seasonal variation.

Approval of a scientific ethics committee was not required as the data is publicly available.

During the study period, we observed a significant increase in RSV for ibuprofen and acetaminophen during mid-March 2020, which greatly subsided in mid-April 2020 to a level comparable to that of the previous period ( Figure 1 ). The search volumes of naproxen and aspirin were stable during the examined period.

Official Journal of the American Academy of Pain Medicine

The observed increases in internet search for ibuprofen and acetaminophen are consistent with the date of the first signed executive stay-at-home order in the United States March 15, 2020 by the Puerto Rico governor, followed by several other states and territories. Surprisingly, we did not observe similar trends for naproxen and aspirin.

There may be a number of explanations for these findings. A recently published survey examined changes in interventional pain physician decision-making, practice patterns and mental health during the early phases of the SARS-CoV-2 pandemic (1). They reported that overall clinic visits and procedural volume decreased to 69% and 13% of prepandemic volume, respectively.

Importantly, survey respondents decreased in-person visits of select groups of high-risk patients by 85-94%. They found that significantly more providers reported increased prescriptions of opioids, muscle relaxants, neuropathic pain medications and acetaminophen. Possible causes of change in prescription patterns include prevention of emergency visits, restriction of interventional options and limited in-person therapeutic treatments (e.g. physical therapy). Changes in systems of care under the pandemic may thus be a contributing factor to our findings. Furthermore, the discrepancy in search trends between OTC analgesics might be explained by differences in usage pattern of medication. According to the Slone Survey among US adults, acetaminophen and ibuprofen are the two most prescribed OTC drugs, whereas aspirin and naproxen are ranked lower (2) . Ibuprofen Acetaminophen Naproxen Aspirin

Making, Practice Patterns, and Mental Health During the Early Phase of the SARS-CoV-2 Global Pandemic

Recent patterns of medication use in the ambulatory adult population in the United States: the Slone survey

EMA advice on the use of NSAIDs for Covid-19

Internet Searches for Unproven COVID-19 Therapies in the United States

Danish Medicines Agency. Paracetamol for children now only available from pharmacies