Sunday, February 11, 2018

Policy Insights from The Neurocritic: Alarm Over Acetaminophen, Ibuprofen Blocking Emotion Is Overblown

Just in time for Valentine's Day, floats in a raft of misleading headlines:

Scientists have found the cure for a broken heart

Painkillers may also mend a broken heart

Taking painkillers could ease heartaches - as well as headaches

Paracetamol and ibuprofen could ease heartaches - as well as headaches

If Tylenol and Advil were so effective in “mending broken hearts”, “easing heartaches”, and providing a “cure for a broken heart”, we would be a society of perpetually happy automatons, wiping away the suffering of breakup and divorce with a mere dose of acetaminophen. We'd have Tylenol epidemics and Advil epidemics to rival the scourge of the present Opioid Epidemic.

Really, people,1 words have meanings. If you exaggerate, readers will believe statements that are blown way out of proportion. And they may even start taking doses of drugs that can harm their kidneys and livers.

These media pieces also have distressing subtitles:

Common painkillers that kill empathy
... some popular painkillers like ibuprofen and acetaminophen have been found to reduce people’s empathy, dull their emotions and change how people process information.

A new scientific review of studies suggests over-the-counter pain medication could be having all sorts of psychological effects that consumers do not expect.

Not only do they block people’s physical pain, they also block emotions.

The authors of the study, published in the journal Policy Insights from the Behavioral and Brain Sciences, write: “In many ways, the reviewed findings are alarming. Consumers assume that when they take an over-the-counter pain medication, it will relieve their physical symptoms, but they do not anticipate broader psychological effects.”

Cheap painkillers affect how people respond to hurt feelings, 'alarming' review reveals
Taking painkillers could ease the pain of hurt feelings as well as headaches, new research has discovered.

The review of studies by the University of California found that women taking drugs such as ibuprofen and paracetamol reported less heartache from emotionally painful experiences, compared with those taking a placebo.

However, the same could not be said for men as the study found their emotions appeared to be heightened by taking the pills.

Researchers said the findings of the review were 'in many ways...alarming'.

I'm here to tell you these worries are greatly exaggerated. Just like there's a Trump tweet for every occasion, there's a Neurocritic post for most of these studies (see below).

A new review in Policy Insights from the Behavioral and Brain Sciences has prompted the recent flurry of headlines. Ratner et al. (2018) reviewed the literature on OTC pain medications.
. . . This work suggests that drugs like acetaminophen and ibuprofen might influence how people experience emotional distress, process cognitive discrepancies, and evaluate stimuli in their environment. These studies have the potential to change our understanding of how popular pain medications influence the millions of people who take them. However, this research is still in its infancy. Further studies are necessary to address the robustness of reported findings and fully characterize the psychological effects of these drugs.

The studies are potentially transformative, yet the research is still in its infancy. The press didn't read the “further studies are necessary” caveat. But I did find one article that took a more modest stance:

Do OTC Pain Relievers Have Psychological Effects?
Ratner wrote that the findings are “in many ways alarming,” but he told MD Magazine that his goal is not so much to raise alarm as it is to prompt additional research. “Something that I want to strongly emphasize is that there are really only a handful of studies that have looked at the psychological effects of these drugs,” he said.

Ratner said a number of questions still need to be answered. For one, there is not enough evidence out there to know to what extent these psychological effects are merely the result of people being in better moods once their pain is gone.

. . .

Ratner also noted that the participants in the studies were not taking the medications because of physical pain, and so the psychological effects might be a difference in cases where the person experienced physical pain and then relief.

For now, Ratner is urging caution and nuanced interpretation of the data. He said stoking fears of these drugs could have negative consequences, as could a full embrace of the pills as mood-altering therapies.

Ha! Not so alarming after all, we see on a blog with 5,732 Twitter followers (as opposed to 2.4 million and 2.9 million for the most popular news pieces). I took 800 mg of ibuprofen before writing this post, and I do not feel any less anxious or disturbed about events in my life. Or even about feeling the need to write this post, with my newly “out” status and all.

There's a Neurocritic post for every occasion...

As a preface to my blog oeuvre, these are topics I care about deeply. I'm someone who has suffered heartache and emotional pain (as most of us have), as well as chronic pain conditions, four invasive surgeries, tremendous loss, depression, anxiety, insomnia, etc.... My criticism does not come lightly.

I'm not entirely on board with studies showing that one dose (or 3 weeks) of Tylenol MAY {or may not} modestly reduce social pain or “existential distress” or empathy as sufficient models of human suffering and its alleviation by OTC drugs. In fact, I have questions about all of these studies.

Suffering from the pain of social rejection? Feel better with TYLENOL® – My first question has always been, why acetaminophen and not aspirin or Advil? Was there a specific mechanism in mind?

Existential Dread of Absurd Social Psychology Studies – Does a short clip of Rabbits (by David Lynch) really produce existential angst and thoughts of death? [DISCLAIMER: I'm a David Lynch fan.]

Tylenol Doesn't Really Blunt Your Emotions – Why did ratings of neutral stimuli differ as a function of treatment (in one condition)?

Does Tylenol Exert its Analgesic Effects via the Spinal Cord? – and perhaps brainstem

Acetaminophen Probably Isn't an "Empathy Killer" – How do very slight variations in personal distress ratings translate to real world empathy?

Advil Increases Social Pain (if you're male) – Reduced hurt from Cyberball exclusion in women, but a disinhibition effect in men (blunting their tendency to suppress their emotional pain)?

...and just for fun:

Vicodin for Social Exclusion – not really – but social pain and physical pain are not interchangeable

Use of Anti-Inflammatories Associated with Threefold Increase in Homicides – cause/effect issue, of course

Scene from Rabbits by David Lynch


1 And by “people” I mean scientists and journalists alike. Read this tweetstorm from Chris Chambers, including:


Ratner KG, Kaczmarek AR, Hong Y. (2018). Can Over-the-Counter Pain Medications Influence Our Thoughts and Emotions? Policy Insights from the Behavioral and Brain Sciences. Feb 6:2372732217748965.

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At February 14, 2018 5:56 AM, Anonymous David J. Littleboy said...

As someone rather deeply into a second language (Japanese, worked as a translator almost 30 years), the whole OTC painkillers kill emotional pain trope screams "bad pun" and "stupid idea by idiots who don't understand how language works". (i.e. people who haven't read "Metaphors we Live by".) I tried to sic one of the folks concerned with the real problems causing the failure to replicate crisis on these things, but he didn't go for it. Sigh. I'm quite sure that when the smoke clears, all these "results" will simply be due to faulty use of statistics. Andrew Gelman has enumerated the ways statistics can go wrong, and these articles reek of the sort of thing that these ways of going wrong cause.

Anyway, your "overblown" understates the incredible stupidity of this inane idea something fierce. Thanks for getting on these idiots cases, though.

At February 17, 2018 6:28 AM, Anonymous Anonymous said...

"If you exaggerate, readers will believe statements that are blown way out of proportion. And they may even start taking doses of drugs that can harm their kidneys and livers."

But it would boos sales. Are these statements made just out or ignorance or because of actual conflicts of interest? With consumer protection laws getting systematically dismantled in the US, what is the incentive for media and corporations against advertising harmful products that would increase their bottom line?

At February 19, 2018 12:19 PM, Blogger The Neurocritic said...

David - Thanks! Wonder why the disinterest from the replication crisis person...

Anonymous - There could be conflict of interest on the part of advertising these OTC products on certain web/news sites, or they could just be going after clicks with sensational headlines.

At February 28, 2018 4:01 AM, Anonymous David J. Littleboy said...

NC: He's either too busy, or I wasn't persuasive enough. Probably some of both, since he is busy, I wasn't as pushy as I sometimes am.

Anonymous: I think this particular problem is more about click-bait than about selling things. Tylenol and ibuprofen are pretty cheap. Popular science articles tend to breathlessly scream the joys of the research being hyped, e.g. XXX CURES CANCER!!! when all that's been found is that XXX makes sick rats live 2 days longer even though it's known to be toxic in humans. I read recently somewhere that while some of this click-baiting is by science writers/editors, a lot of it is by the publicity department at the institution where the research was done, and the science writers/editors are just repeating what they've been told. Sigh.

Hey NC: I hope you are hanging in there and am glad to see you blogging.


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