A social analgesic? Acetaminophen (paracetamol) reduces positive empathy

4 years ago (ncbi.nlm.nih.gov)

Acetaminophen (paracetamol) is also associated with reductions in 'social pain'.[0]

> Thus, acetaminophen reduces behavioral and neural responses associated with the pain of social rejection, demonstrating substantial overlap between social and physical pain.

It's a fascinating idea that social pain and physical pain are so strongly related. That depression can be viewed as a form of chronic pain, like a knee that still hurts long after the injury has healed.

And perhaps then positive empathy has something to do with literally feeling the social pain of others- blunt your ability to feel social pain and you aren't as affected by it.

[0]https://journals.sagepub.com/doi/abs/10.1177/095679761037474...

Pain is psychosomatic. A broken heart physically hurts, and a broken bone will ruin your mood. A similar result was found in parents with opiate abuse disorder, they were less likely to notice negative emotional states when shown pictures of children in various moods. I don't think this result is concerning except for people who are taking NSAIDs on a daily basis for long periods of time.

  • > and a broken bone will ruin your mood

    Curious thing I've noticed - physical ailments had very little effect on my mood as a child, but have a significant impact on my mood in my 30s. Something even as simple as a cold can make me unwilling to be helpful, empathetic, etc now.

    Why is this?

It also reduces compensatory affirmation:

The Common Pain of Surrealism and Death: Acetaminophen Reduces Compensatory Affirmation Following Meaning Threats

https://www2.psych.ubc.ca/~heine/docs/2013%20Acetaminophen%2...

> They ... watched a 4-min clip from the short film Rabbits, created by David Lynch (2002)

> acetaminophen interrupts the typical compensatory responses to meaning threats ...

> acetaminophen has more far-reaching psychological consequences than previously realized

Though not a huge n, n=121.

You have to suspect that the underlying reason people are taking a pain reliever in the first place also makes them less empathetic to others. That could even be a larger effect than the one found in the study.

Understand that's controlled for in the OA, just mentioning another aspect in real-life situations.

  • In this experiment participants didn't get to choose whether they would get paracetamol or not, so that shouldn't be a factor.

    • Right, I mentioned it was controlled for. I meant people not in a study, that are in pain, being less empathetic to others.

      The study showed that people taking this drug became less empathetic, due to the drug, not the pain. I'm saying there is an additional consideration based on experiencing pain, that you then may or may not take drugs for, but that has its own effect.

  • Are you saying that you think people who want relief from their own pain are people who have reduced empathy toward others?

    • It might be that just being in pain yourself can lower your empathy. For example your body could raise pain threshold a bit so it's easier for you to suffer your pain which could cause empathetic pain not to register at all.

Another study linking these. The prospect of humans in some places maybe experiencing different things and making different decisions than they would've because for a couple generations everyone has been taking a ton of Tylenol and it reduced everyone's collective empathy... that is terrifying to me.

  • What’s terrifying to me is the casual nature of use of this powerful drug. Even for the slightest pain we’ll take a couple of basically free pills and think nothing of it. The older you get the more power you have the more aches and pains the less empathy.

    Huh. Explains a bit! :)

    The links with adhd and autism are scary too.

    My hypochondriac mother guzzled these pills like candy.

It would be interesting to see a study on whether Tylenol reduces empathy in people who are sick/in chronic pain. My guess would be that Tylenol increases empathy in these situations, despite the general effect it has in reducing empathy. It's hard to empathize with others when you're in pain yourself.

Brings about a good question - if you have a headache, and you take Tylenol, do you become more or less empathetic? If the answer is you become more empathetic, that indicates that instead of Tylenol being the bad guy, we should try to reduce the prevalence of headaches (or pains that cause people to take Tylenol) in general.

Sounds like a hack for people with social anxiety as well.

When I can't sleep because my mind is racing, or I am anxious about something, I take 1000mg of acetaminophen, the stress is relieved, and within an hour I am asleep.

When bad things happen to me, or I'm anxious about something, I take 1000mg of acetaminophen and the stress is quickly blunted.

Acetaminophen is a miracle drug for psychological pain, and it is very safe if used occasionally in small doses (as described above).

  • I use weed for both these cases—shutting my mind up so I can sleep and/or dulling physical pain in case of illness so I can sleep, if it doesn't rise to the level of needing/being-able-to-get serious painkillers, plus (at lower doses, and far less often) for reducing anxiety during waking hours.

    Works great, wish I'd started years ago. Leaves me much better-rested in the morning than other prescription sleep aids I've tried. On nights when I know I'll have a nice 9ish hours uninterrupted, I pair it with a little melatonin to keep me from waking up completely if I stir a little after the weed's worn off, and it's the best damn sleep of my life.

    A+++++ would recommend. Screw you for lying to me, William S. Sessions.

    • When it became legal here several years ago, I tried it out a bunch. Turns out I'm the kind of person that cannabis generally makes anxious/paranoid. Probably for the best, but I'm kind of bummed it isn't as fun as people always made it out to be.

  • I don't think 1000mg is a small dose, I'm not a doctor but that seems like an extra-strength portion to me

    • Acetaminophen has an active dose very close to the lethal dose, and is the leading cause of acute liver failure in the United States. While the daily limit is 4000mg, 1000mg is not un-common in formulations like extra-strength Tylenol.

    • The "standard dosage unit" in Canada is 325 mg (for adults), with extra-strength pills containing 500 or 650 mg.

      1000 mg is pushing the daily limit (4000 mg, but it's got a halflife of ~6 hrs, so...)

      3 replies →

  • > it is very safe if used occasionally in small doses (as described above).

    Define occasionally, and small doses. Paracetamol/acetaminophen is widely considered to be dangerous for a few reasons - sustained use of "safe" dosages has been shown to have a huge effect on liver failure [0] - it's regularly found in other painkiller, cold & flu, decongestant, and antihistamines. - It's surprisingly ineffective for a large number of people for lots of different kinds of pain - The dosage that can cause critical liver damage is _dangerously_ close to the therapeutic dose.

    [0] https://link.springer.com/article/10.1007/s40264-012-0013-7

    • Commenter was explicit about dosage and pretty clear about frequency. A single dose of 1,000 milligrams in a 24 hour period is indeed small and universally considered to be safe for people with a normal liver.

  • Trazodone is a much safer prescription sleep aid. For non-prescription rhodiola or ashgawandha maybe, but if you're anxious about something it's much better to get rid of the source of the anxiety.

  • I take an anti-histamine. They don’t usually make me drowsy, but if I am wake at 3AM and feel too awake, the anti-histamine is usually enough to push me back to sleep (although it isn’t immediate).

    • Antihistamines like Benadryl are anticholinergics. They are harmful to the brain and everyone should avoid them. In contrast acetaminophen is universally considered to be safe for people with a normal liver.

      1 reply →

Related and more accessible article from BBC Future (must read) - The medications that change who we are : https://www.bbc.com/future/article/20200108-the-medications-...

Excerpt:

Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.

Mischkowski wondered whether painkillers might be making it harder to experience empathy

And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.

For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.

Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).

The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.

I have BPD and I self medicate with low dose Paracetamol. It makes me feel less mental pain and also less guilt/empathy that is in excess for others. It helps me function better than my medication which is quite funny.

  • Would you please share dosage, and maybe other circumstances? I'm really curious what you do and what effects you experience.

    • 1000mg doses in the morning and evening. I was on Effexor and self-medicating with opioids ocassionally. The BPD is from childhood. Since Paracetamol experiment I dropped all the other drugs, I am totally functional and focused on my work now (the mental anguish was distracting and unmotivating). I am sure this is not good for my liver but I could take a reduced lifespan over the torture that is this disorder.

      1 reply →

a "potent" physical painkiller .

Does anyone know if the word potent here is meant to be scientific or emotional? It feels emotional, the dictionary definition is "having great power, influence, or effect." which seems weird to jump out the gate with such a subjective word for an over the counter painkiller.

I wonder if people with naturally high pain tolerance would also have reduced positive empathy?

Psych study with n=114. Given the reproducibility crisis in psychology, I'll wait for the replication.

  • Sure, do that. But also:

    > The power analysis used a power criterion of (1 − β) = 0.80, which indicated that a mean cell size of n = 54 was sufficient to replicate significant effects of acetaminophen.

    The question is not whether n=114 is "large enough" because that question, by itself, does not make sense. The question is whether n=114 is "large enough for the observed effect." Given that the p-values for the "personal pleasure" and "empathetic feelings" measures are under 0.001, the answer is "yes," potential methodological issues notwithstanding.

    • Disagree from experience. I find it far more likely that they considered how to skew the p-values low enough to where they become significant. “Personal pleasure” & “Empathetic feelings” do NOT sound like terms which correlate to reproducibility to me.

      6 replies →

  • I don't think you should sneer at a triple-digit sample size that's justified with a power analysis based on their previous work.

    I agree that you'd want to see replications before making any major decisions--these effects are often finnicky--but this seems to me like a reasonable-sized step forward.

    • They also had a prior justification for running this experiment based on known effects of Tylenol on the brain.

  • Seems like every time now, when I read a medical study, especially psychiatry-related, I'm shocked that it could even be published. I have no training in the field, so nobody would take me seriously and I even doubt myself, but the study designs just seem so poor

  • I tend to agree. While I think the sample size is fine, the way perceived positivity and perceived pleasure were measured seems pretty subjective in a way I find hard to generalize.

    The paper does seem awfully suggestive, though. Worthy of more exploration for sure.

  • All undergrads from a single university also. Just based on the social development of people as they go through undergrad, I'd guess that the variance in behavioural change before and after treatment is fairly high whether they're treated or not.

    • Just like a lot of pharma papers need a `... in mice` appended to their titles, a lot of psych papers need `... in undergrads` appended to theirs.

Always fun to read about how doctors recently learn about things that everyone else already knew and have coined the term "common sense" for.

Just remember, don't take Tylenol if you are in pain, as you can die from liver poisoning quite quickly. "Engstrom suffered an accident in the lab when a monitor fell on his foot. He took too much Tylenol which caused liver toxicity, and died on December 1, 2020"[0].

[0]: https://en.wikipedia.org/wiki/Eric_Engstrom

  • I don't see how you make a leap from "he took too much Tylenol" to "don't take Tylenol".

    Anything will kill you in a large enough dose. Drinking water will.

  • Possibly the important missed part here: the effective dose for paracetamol is alarmingly close to the dangerous dose.

    Dosage rules allow for 4g/day, 5g/day can cause liver damage. It's also common to find paracetamol in multiple products - so you can take some painkillers, then not realise that the lemsip you're taking for the sniffles also has paracetamol and now you've put your liver at risk.

So perhaps acetaminophen (Tylenol) is responsible for the increasing political divide in the USA and in the world? People literally care less about each other because their empathy is being blunted. How long does the effect last? Days at least if I remember previous reports correctly. There are a LOT of people using acetaminophen often. If the effect lasted a week would just one pill a week make you a less caring person? This seems like it could be a really big deal.

Acetaminophen is best avoided in my opinion. Long term liver damage is a major issue, particularly in conjunction with alcohol. There's also some evidence it's linked to cancer, and why take the risk? Ibuprofen (Advil) is probably much preferable in most cases, though definitely not for long-term chronic pain.

Long-term chronic pain is one condition where opiates actually make sense, although studies demonstrate that using cannabis + opiates allows the opiate dosage to be kept below the addiction threshold while providing equivalent relief.

  • > There's also some evidence it's linked to cancer

    Isn’t everything? I would love to see a site that was more about the relative risks of cancer. Or even better, that queries us for our behaviours and then suggests where to spend our efforts to improve our quality of life, based on well supported research.

  • Acetaminophen doesn't cause long-term liver damage, it causes acute damage. The liver is very good at recovering from things as long as you don't poison it all at once.

    It's actually ibuprofen that has the long-term risks, it will hurt your kidneys and stomach lining.