Your pain reliever may also be diminishing your joy | Hacker News Reader

Your pain reliever may also be diminishing your joy

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58 pointshydrogen1838 comments

I have to bring this up in case someone decides to self-experiment: http://en.wikipedia.org/wiki/Paracetamol_toxicity

TL;DR: Don't take more than 3 grams a day.

Also, take care to notice how many other medicines have acetaminophen/paracetamol. If you take tylenol for pain and also take cough syrup then you could be doubling up on paracetamol. If you take too much of each, which is common, and maybe take the 2nd dose a little too soon after the 1st, and maybe if you have a habit of chronic drinking you could easily get yourself into severe trouble without even knowing it.

Agreed, that's why it's better to get paracetamol-free variants of medicines if available.

Also, caffeine makes paracetamol more effective for pain relief. There are pills available with paracetamol + 50mg caffeine (or just take two cups of coffee); this may be more effective than doubling up on the paracetamol.

Unfortunately, the DEA and US public like to poison people with APAP to reduce the perceived danger from opiates. Someone, literally, decided that if you add APAP to hydrocodone then it can be under a lesser restriction (Schedule III). Not to mention the doctors that go along with this wickedness and are very hesitant to prescribe opiates without APAP.

And just look at the outrage a year or two back when Zohydro was announced. All they did was remove APAP from hydrocodone tablets, but it was spun as creating super power heroin for everyone.

I was going to argue that combining paracetamol (APAP) with opiates might make them more effective for pain relief, but then I found this, which points to the opposite (i.e., adding APAP may not increase pain relief): http://www.ncbi.nlm.nih.gov/pubmed/17965980

I didn't read the paper, only the abstract.

People used to think that combining the two would make them both more effective allowing you to use less of both, thus reducing the toxicity. See for example coproxamol which has a sub-therapeutic dose of paracetamol and dextropropoxyphene. Paracetamol in overdose is very dangerous, but this drug kills you before the paracetamol does becausethe opiate (opiod?) used is so toxic.

There's a bunch of stuff about long term pain that we had very wrong ideas about and that we're only recently getting better understanding of.

Opiates are incredibly non-toxic compared to APAP. So adding the latter to reduce the former is ... misguided at best.

It's just classic puritanical morality run amok, as usual. They'd rather that some people died from paracetamol overdoses than be allowed to live as "sinners".

Not really. Opiates are terrifyingly addictive, especially compared to paracetamol, and inhibit your senses and abilities far more than paracetamol. Their side effects when mixed with other commonly (ab)used products such as alcohol, diazepam are far more dangerous than the interactions those other drugs have with paracetamol. There is definitely a reason to be concerned when companies are pushing out more variations on existing products.

I'm NOT saying that the appropriate reaction is to get up in arms about companies pushing opiates, but some care should be taken. I don't know what the correct solution is, but I'd hazard a guess that freeing the sale of opiates to anyone over the counter tomorrow will result in more problems than we have currenty. Especially as there are other less drastic alternatives available for various pain sources.

In the context of pain relief, there are also issues like building a tolerance and developing increased pain sensitivity due to long-term use of opiates.

I've definitely noticed a massively increased tolerance for opiates, but not an increase in pain sensitivity.

You wouldn't notice the sensitivity unless you are completely off the drug

Did you read the post you're replying to? I didn't see anything in there about "freeing the sale of opiates to anyone over the counter tomorrow." I did see a reasonable concern that adding paracetemol to prescription opiates can lead to liver failure and death. And you don't have to be an evil drug addict hippie scum to be bothered by this. People who take multiple medications prescribed by multiple doctors might be damaging their livers without even knowing it.

There is no logical reason, besides the "drug war", to add paracetemol to prescription opiates. Is your argument really that because opiates might have "side effects when mixed with other commonly abused products such as alcohol"... that therefore we should stuff them with paracetemol? It's safer to kill people who overdose or get addicted than let them experience a possible bad drug interaction with alcohol? I don't think you thought this through.

Two cups of coffee would be closer to 200 - 300mg of caffeine. (source: google and http://www.cspinet.org/new/cafchart.htm for more details).

Thanks, I'm sure I read 50mg == 2 cups somewhere, but it's incorrect.

Formulations with ibuprofen and other less toxic NSAIDs exist, though they all have their drawbacks. Look for them. There's really no reason to be ingesting Tylenol if you don't have to.

Not that I'm recommending anyone come remotely close to risking an acetaminophen overdose — or that if they do end up overdosing, they try to treat it themselves — but the dietary supplement N-Acetyl Cysteine is a first-line treatment for acetaminophen poisoning. It appears to work equally well whether it's taken orally or intravenously, though the oral course takes longer and prevents the concurrent use of activated charcoal to limit the body's absorption of the drug.

For those outside the US, it seems acetaminophen is the same as paracetamol.

It’s paracetamol in the UK too.

I remember reading a while back that acetaminophen can dull existential dread.

http://healthland.time.com/2013/04/19/tylenol-fights-fear-of...

Pain also dimishes my joy. Pain relievers are shit, but pain is far worse.

I often wonder if there is a way to fix the dislike/uncomforted of pain without removing it. Rather then bombarding your body to inhibit this feeling.

Meditation practitioners manage to dissociate the experience of pain from the emotional response that usually comes with it (with fMRI at least one (edit: two) fMRI study that shows the dissociation as well, in that areas associated with the emotional processing of pain are less turned on by painful stimuli, while the rest of the pain detection areas light up normally).

http://www.sciencedirect.com/science/article/pii/S0304395910...

http://www.jneurosci.org/content/31/14/5540.short

Meditation is supposed to be able to achieve this.

I've experienced it exactly once in a 45-minute session and it only lasted a few minutes. At the time my elbow was hurting quite a bit (I have hemophilia and arthritic damage from frequent bleeds); for that brief duration, I continued to experience the pain but it was akin to observing that an object is a particular colour, rather than suffering personally.

Achieving the desired mental states of meditation is hard for most people. We're so used to constantly moving about with our minds flitting from one thing to another Meditation is precisely the opposite of that.

But if you do there are many great benefits, including reducing the suffering of physical pain. Like you said, you can reach a mental state where you just observe the physical pain - you know it is there but you don't suffer from it.

Disclaimer: I was a Buddhist monk for a while. I meditated a lot.

While the state lasted, it was extremely interesting. It's one thing to read about it, and another to experience it. It's the simplicity that was so surprising. At the time I almost laughed when I remembered how I would normally react to what was just a painful joint. That's when I lost my grip, so to speak, and went back to feeling ow, ow, ow.

Yeah, holding on to that state is a challenge. Need to experience it many times so the mind gets in the habit of just slipping into it. Problem is, when you try too hard to get there you can't. You're grasping, clinging, which defeats you. Gotta let go, as they say. It's subtle, but profound.

I suffer from bad back pain from a slipped disc. Yoga has a surprisingly positive effect on me. Although I can't quite do most of the poses and stretches, the hour or so of stretching has an overwhelmingly soothing effect on the pain and my attitude towards it.

There's a huge amount of interesting work in this area.

Others have mentioned meditation. There are various efforts at mindfulness, acceptance, and so on. The results seem generally positive, but there's a long way to go yet. Those interested may want to have a trawl through the literature, which is of varying quality [1].

It is possible to have pain without tissue "damage"; to have damage without pain; to have pain without suffering [see footnote]. Some work is aimed at manipulating this symbolism within the brain. Most people are probably familiar with mirror-box therapy [2], which is one among several efforts at translating the neuroscience of pain (a-)symbolia into useful clinical practice. Other efforts I find interesting include Graded Motor Imagery [3] and Recognise [4] from the Neuro Orthopaedic Institute. These are both rehabilitative programmes based on the finding that people with chronic musculoskeletal pain often have altered processing of their "body map".

A large and fascinating area of research and clinical work.

[1] http://www.ncbi.nlm.nih.gov/pubmed/?term=(acceptance+OR+mind...

[2] http://en.wikipedia.org/wiki/Mirror_box

[3] http://www.gradedmotorimagery.com/

[4] http://www.noigroup.com/recognise

[Footnote]

Pain without tissue "damage". We can throw any number of tests at people with certain conditions (chronic low back pain is a classic example) and fail to determine anything "wrong" or "damaged". In fact, this may make things worse by uncovering benign issues and treating them, thereby both failing to address the problem, and potentially introducing further iatrogenic side-effects. Now, the fact that we cannot find any "damage" (or tissue change) doesn't mean that it doesn't exist. So this may be a "measurement problem": our investigations are simply not yet sophisticated enough. However it underlines the complex nature of pain (Ronald Melzack's "neuromatrix" theory of pain is probably the most useful we currently have).

Damage without pain. Other than in rare disorders where pain is totally absent, everyone can experience damage without pain. Surfers report shark attacks as feeling like a "bump" when they've lost an entire limb. Stabbing or shooting victims can be unaware of what has happened until they see blood. A more easily-imagined example: you twist your ankle while crossing railroad tracks just as a train is hurtling toward you. You get up and run. Only minutes later, when the adrenaline has subsided, do you start to feel ascending pain.

Pain without suffering. This is the most important distinction, and something that meditation, mindfulness etc probably address. You can have pain, but do you have to suffer? Certainly suffering can increase if your mood is low, whether through depression, circumstance, or whatever. Different people with "the same" (subjective) injury or tissue damage can report wildly different levels of pain i.e. their suffering is different. When the mechanisms of pain production cannot easily be addressed, psychological interventions to address the suffering become increasingly important. (That's not to say the nociception and pain should be ignored -- they should be addressed too).

There are various examples of pain without suffering. Everyone has picked a scab or squeezed a zit or poked a mouth ulcer, knowing it will "hurt" but without that necessarily being bad. There are plenty of other examples, some quite titillating, of folks who seek out pain but certainly aren't suffering.

So yes. A large and complex area.

(Edit: words.)

Anecdotally, I notice something similar with Naproxen -- it's great for diminished pain from aches and pains, but it also seems to make life less exciting.

Clearly they're using the wrong pain reliever. ;)

> So the researchers did a second study in which they had 85 people view the same photos and make the same judgments of evaluation and emotional reactions as in the prior study.

> Once again, individuals who took acetaminophen (compared to placebo) had evaluations and emotional reactions to both negative and positive photographs that were significantly blunted.

Couldn't a possible explanation for this be that the "judging" was already done the first time(under the effects of paracetamol) and the brain simply reuses the "cached" judgment?

I think you're misreading the study design. 85 people viewed the same photos, some of whom had taken acetaminophen, and some of whom hadn't. The researchers then compared the emotional intensity experienced by the two groups (and, in the specific study about which you're quoting, the participants' experience of the color blue).

> Compared to placebo.

At this point we'd have to make sure if any part of this effect is permanent, or whether it all disappears when the drug is metabolized.

Well, if it is permanent there would be no difference in the placebo group. Anyone who isn't allergic to acetaminophen and live in the west has taking at least a 500mg dose in their lifetime. Even if you consciously tried to avoid it, there is a good chance you were administered it before or after surgery.

That's a pretty scary thought.

Why? Acetaminophen makes you act differently. Big deal. It isn't as if we're all being administered drugs like in Equilibrium.

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