Chronic Pain Conditions and Over-the-Counter Analgesic Purchases in U.S. Households: An Analysis of Nielsen-Kilts Ailment and Consumer Panel Data (2023)

Response to Reviewer 1 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Yes

Is the research design appropriate?

Yes

Are the methods adequately described?

Must be improved

Are the results clearly presented?

Must be improved

Are the conclusions supported by the results?

Must be improved

Are all figures and tables clear and well-presented?

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1: please avoid abbreviation in the abstract

Response 1: Thank you for pointing this out. We agree with this comment. Therefore, we have updated the abstract.

We have enabled track changes in the revised manuscript. This change can be found – page number 1, paragraph 1, and line 11-28.

Comments 2: please provide if there were any previous studies using both ailment and purchasing data from NielsenIQ? If so, please clarify  how this manuscript provides nowel insight

Response 2: Thank you for pointing this out. We agree with this comment. Therefore, we have updated the introduction.

We have enabled track changes in the revised manuscript. This change can be found – page number 2,3; paragraph 6, and line 94-102.

Comments 3: Were household reporting both pain-related and non-pain ailments included in multiple categories, excluded, or placed into one group only? If so, by what rule?

Response 3: Agree. We have updated the footnote for Table 3 for more clarification. In the initial analysis of household-level ailments, we examined multiple reports of symptoms—specifically, whether any household member experienced pain or not—to gain a deeper understanding of the overall pattern (Table 1 and Table 2). To explore the relationship between health status and household expenses, we categorized households into three distinct groups: those reporting pain-related ailments, those with non-pain-related ailments, and those reporting no ailments at all (Table 3).

We have enabled track changes in the revised manuscript. This change can be found – page number 7; paragraph 1, and line 249-250.

Comments 4: Is there any possibility to include units or package size in this manuscript or in future analyses? Total expenditures may not reliably reflect intensity or chronicity of use

Response 4:

Thank you for pointing this out — your observation is much appreciated. The package-level information is indeed more granular and requires further research to break it down effectively. We do have plans to incorporate this level of detail in future analyses, particularly for painkiller products.

For context, we have already conducted a detailed analysis of Nicotine Replacement Therapy (NRT) purchases by quantity and product type (the paper in the final stages of the review process), as the NRT categories are well-defined and guided by clear clinical standards. However, painkiller products present a greater challenge due to the extensive variety available. Analyzing them will require additional time, effort, and a thorough review of the relevant literature.

Comments 5: Is it possible t include household education, income, or insurance status? These could provide critical insight into why certain groups rely more on OTC medication

Response 5: Thank you for highlighting this. Your input is greatly valued. While income data is available, it corresponds to two years prior to the panel year. Additionally, although other relevant variables exist within the consumer panel dataset, we are only able to link them at the member level. Unfortunately, we cannot map individual member information directly to the ailment data due to the lack of one-to-one identifiers beyond the household code.

Comments 6: Please state whether this dataset includes online vs in-store purchase, and how those are validated

Response 6: Thank you for bringing this to our attention. NielsenIQ tracks consumer purchases across more than 50 retail channels, including dollar stores, drugstores, grocery stores, online platforms, and others. Their panel comprises approximately 40,000 to 60,000 U.S. households, with data collected through in-home scanning of purchased items.

4. Response to Comments on the Quality of English Language

Point 1: The English is fine and does not require any improvement.

Response 1: No response

5. Additional clarifications

Response to Reviewer 1 Comments

1. Summary

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Does the introduction provide sufficient background and include all relevant references?

Yes

Is the research design appropriate?

Yes

Are the methods adequately described?

Yes

Are the results clearly presented?

Yes

Are the conclusions supported by the results?

Yes

Are all figures and tables clear and well-presented?

Yes

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1: Introduction, line 77-90: please define the research gap clearly, i.e. the significance of the presented research

Response 1: Thank you for pointing this out. We agree with this comment. Therefore, we have update the introduction.

We have enabled track changes in the revised manuscript. This change can be found – page number 2,3; paragraph 6, and line 94-104.

Comments 2: Table 5: please indicate which test was used for the p value in the footnote.

Response 2: Agree. We have, accordingly, added the footnote to emphasize this point.

We have enabled track changes in the revised manuscript. This change can be found – page number 8; footnote, and line 293.

Comments 3: Discussion: the statements about gender and age disparities are over-interpreted, please revise.

Response 3: Agree. We have, accordingly, revised the discussion to emphasize this point.

We have enabled track changes in the revised manuscript. This change can be found – page number 8,9; paragraph 3, and line 316-326.

Comments 4: Conclusion: this section should be tightened.

Response 4: Agree. We have, accordingly, revised the conclusion to emphasize this point.

We have enabled track changes in the revised manuscript. This change can be found – page number 10; paragraph 3, and line 387-394.

4. Response to Comments on the Quality of English Language

Point 1: The English is fine and does not require any improvement.

Response 1: No response

5. Additional clarifications