What's Tylenol Doing to Our Minds?

http://www.theatlantic.com/health/archive/2013/04/whats-tylenol-doing-to-our-minds/275101/

by BruceM • 13 years ago

218 148 13 years ago

DanBC7• 13 years ago

It is pleasing to see error bars on a graph in a mainstream publication. It's very nice to have them saying that the study was small and there are more questions to be asked.

It's good that they mentioned the severe toxicity of paracetamol in overdose. It does kill many people, and it's not a pleasant death. It also accounts for many organ transplants.

It would have been nice if they'd said that, taken carefully and with no over dose, paracetamol is a very safe and very effective medication. It's very cheap. (At least here in the UK, I found it bafflingly expensive in the US.)

Cultural note: In the UK most medication is dispensed in blister packs. You can buy paracetamol off the shelf but you can only get limited quantities. Most shops will only sell you 16 tablets (at 500 g each) or 32 if you buy it from a person. You can get 100 if you see a pharmacist and persuade them you need them, but that'll be a struggle in most places. You can get large amounts if you have a prescription. 16 tablets at 500 g each would cost around £0.20 (for budget pills). Blister packs was an effective suicide control measure, reducing the number of pills taken and the number of overdoses attempted. Reduced quantities of pills sold had an initial success in reducing suicide rates, but number have since risen. Pills in the homes of old people are especially dangerous. This is because they're not locked away, and young children visiting sometimes take the pills. And also because suicide rates among old people are depressingly high.

_delirium5• 13 years ago

> I found it bafflingly expensive in the US.

Brand-name Tylenol is relatively expensive, but generic acetaminophen/paracetamol is dirt cheap in the US. Here are 200 tablets of 500 mg each for $4.00, i.e. $0.02 per tablet: http://www.walmart.com/ip/Equate-Extra-Strength-Value-Pack-A...

andrewcooke2• 13 years ago

you can buy paracetamol in packs of 200? jeez. isn't this one of the main killers, though overdoses (many accidental)? i'm pretty sure size for otc sale is regulated in other countries.

paracetamol is nasty stuff - dying from it is not pleasant, and it's surprisingly easy to do.

bane• 13 years ago

Here's 1000 for less than $11.

http://www.costco.com/Kirkland-Signature%E2%84%A2-Extra-Stre...

joosters2• 13 years ago

It's expensive in the UK too if you buy a brand name painkiller. It's depressing that they can still sell them when the identical generic medication is next to them on the shelf and is 1/10 of the price.

kintamanimatt• 13 years ago

> It's depressing that they can still sell them

You may feel better about this if you take some Tylenol ;-)

I don't see how there's anything wrong with selling brand-name drugs next to generics. In fact people that believe brand name drugs are more effective will have a better response to the more expensive drug because of the placebo effect. If anything, they're getting a better response to the same dose of the same drug than the rest of us plebs that know better than to pay a multiple of the cost of the generic.

gambiting3• 13 years ago

To be honest, I find the UK law to be absolutely stupid in this regard. I needed to buy 10 packs of paracetamol, and at local morrisons I was told I couldn't, maximum was 2 packs(16 tablets each). So I bought two packs, went out of the store, came back in, bought another two, repeated the process 5x and got my ten packs. The whole law is just an annoyance, nothing else. If I wanted to kill myself with paracetamol I could easily get even a 1000 tablets, would just need to drive around a few supermarkets but this law would not stop me from doing it.

Osmium2• 13 years ago

> The whole law is just an annoyance, nothing else.

This is not true. It's about preventing impulsive suicides, not premeditated ones. If a depressed person is having an episode and all they have in their house is 16 pills, then it removes the opportunity: maybe by the time they've make it to the shops and buy more, the moment will have passed, and a life would be saved.

It's been shown time and time again that you can reduce absolute suicide rates by removing opportunities like this. If I remember correctly, there was something similar involving gas ovens, though I can't find the reference now. Guns, bridges, etc. are all similar too.

When it comes down to it, if someone's determined enough to kill themselves, they will, but the truth is most people aren't and doing things like only selling small quantities of pills really can prevent suicides.

Someone2• 13 years ago

Firstly, I have trouble thinking of situations where one would need to buy 10 packs of paracetamol. Care to elaborate?

Secondly, one cannot prevent one from committing suicide, but making it harder will give people time to reconsider their planned suicide.

andrewcooke2• 13 years ago

confused old people die from paracetamol overdoses. this helps reduce that, afaik (no evidence to hand, but read up on painkillers not long ago as i needed to take them over a fairly long period). and given that you could work around it easily, it seems that the cost to others is not so high...

coolestuk3• 13 years ago

The UK law is stupid. My sister took her life using paracetamol. She just drove to 3 different pharmacies and bought the max amount at each. She also bought sleeping tablets so that the pain of her dying liver would not wake her.

A few days before this, my family had tried to have her sectioned as mentally ill (she was suicidal from post-natal depression). They psychiatrists kept her in for observation for 48 hours, then released her. 24 hours later she was dead, and her child an orphan.

All the law did was slow her down for maybe 15 minutes in her suicide attempt.

cmelbye• 13 years ago

Bafflingly expensive? It's dirt cheap, and readily available for a few bucks in pill bottles with 100+ pills from any drug store.

mtdewcmu• 13 years ago

The UK must accept a much greater level of paternalism in health care than in the US.

graywh• 13 years ago

> It is pleasing to see error bars on a graph in a mainstream publication.

Those are "dynamite plots", a favorite of scientists, but the statisticians I know prefer to use boxplots or dotplots instead.

Shenglong• 13 years ago

I'm not all that familiar with social tests like this. Is n=120 generally considered to be a large enough sample size to make any claims at all?

carbocation6• 13 years ago

It always depends on the effect size.

icegreentea2• 13 years ago

Another important question is always, 'if this effect is true does this generalize to the overall population'. While I haven't read the paper, I bet that the test population were composed almost completely of undergrad students. So much of social science experiments are based on testing done on student. And there isn't anything wrong with that per se, but we must always be careful when trying to infer results, and drawing conclusions on the greater population, or human kind as a whole.

pekk• 13 years ago

n=120 pales utterly beside the observation that it is totally unclear what they are actually manipulating or measuring. The design is completely hapless.

If you really need to detect effects that are so small they are meaningless for almost any practical purpose, then you might need thousands of people in the study.

Xcelerate• 13 years ago

Just because you think a study seems too small doesn't mean it is scientifically invalid. There are actually statistical tests you can use just for the specific purpose of determining validity. These are much better than some intuitive hunch you might have about the study.

joosters2• 13 years ago

Possibly a dumb question, by why is it called acetaminophen in some places and paracetamol in others? Neither of them are a brand name AFAIK.

Rinum• 13 years ago

Its chemical name is para-acetylaminophenol. That's what the names acetaminophen and paracetamol are derived from.

para-ACETylAMINOPHENol

PARa-ACETylAMinophenOL

spicyj• 13 years ago

para-aceTYLaminophENOL

icegreentea2• 13 years ago

The full chemical name (but not the IUPAC name) is N-acetyl-para-aminophenol. Acetaminophen and paracetamol are just various shortenings of the name. Likely whatever is popular in a location just comes down to whatever dominant drug manufacturer chose to call it in their public facing material.

pygy_• 13 years ago

Among other things, paracetamol activates the cannabis receptors.

http://www.ncbi.nlm.nih.gov/pubmed/17227290

Breakthrough• 13 years ago

Always great to see studies looking at the mental implications of non-psychoactive drugs. I suppose it's common to overlook the implications of a drug on the central nervous system with respect to consciousness, when the drug in question never causes any subjective/noticeable change.

I suppose it's all too intuitive, though. Even slight, unnoticeable changes in consciousness - to the point that even you don't notice - may in-fact be detectable on paper. I hope this leads to more research into the mental changes for other drugs classified as "non-psychoactive" (who doesn't love more data? :). Anyways, to end off by inserting some colloquialism into my thoughts here...

Trippy study, mannnnn.

freshfruit2• 13 years ago

> Always great to see studies looking at the mental implications of non-psychoactive drugs.

... also great to read about the mental implications of priming. I'll be more punitive/forgiving depending on the unrelated thought I had minutes earlier...

raverbashing• 13 years ago

> Always great to see studies looking at the mental implications of non-psychoactive drugs.

Well, it kind of fits the definition (except psychoactive drugs have their primary effect in the brain)

npsimons3• 13 years ago

As someone with a family history of mental illness, I try to keep a close eye on my mental state, and it's surprising how much can affect it. Apart from drugs that shouldn't be affecting mental states, even different types of food and how much exercise I get can have noticeable impacts. Those EFA fish oil pills? Not just good for your heart . . .

freshfruit2• 13 years ago

I think you're promoting a healthy degree of self-awareness.

A noteworthy risk however is that you'll make false connections -- ie. garlic is good for fight off HIV.

tosseraccount4• 13 years ago

Just legalize opiods. Do you really need a Doctor when you stub your toe?

carbocation6• 13 years ago

If you take opioids for the pain from stubbing your toe, you should re-evaluate what is important to you.

tosseraccount4• 13 years ago

Like getting by for 24 hours until I can put shoes on? I need the government to tell me I can't ease things for a day?

tsotha• 13 years ago

Perhaps. But should the government be doing that evaluation for you ahead of time?

derleth• 13 years ago

If you need opioids for the pain from a stubbed toe, you have a serious problem with something (mental, physical, or both) and need more help than an OTC opioid can give.

tosseraccount4• 13 years ago

Like the article says, too much Tylenol causes brain damage.

gte910h• 13 years ago

EXTREMELY small study. Just push for a larger study on this

http://www.academia.edu/2057894/The_common_pain_of_surrealis...

121 people

Search for "We recruited"

simonster4• 13 years ago

In Study 2 there we 236 subjects, which AFAIK is a pretty big sample size for these kinds of experiments. There error bars on the graph are still somewhat large, so there was a lot of variability, but assuming there is no bias in what data the experimenters chose to include, combining both studies, p < .02*.01 = .002. Furthermore, as the article notes, there was a prior study that also showed cognitive effects of Tylenol. While these effects could be spurious due to publication or selection bias or deliberate manipulation, it's not all that plausible that they happened by chance.

carbocation6• 13 years ago

Just multiplying the P-values from different studies is invalid.

You can intuit this by imagining 10000 studies, each of which had a P-value of 0.99. Seeing 10000 negative studies and no positive studies, you'd be convinced that there was no real effect, intuitively. But multiplying 0.99 10000 times yields a P-value of 2.2 x 10^(-44), a result of impressive significance.

To combine studies, many people use inverse variance weighted meta-analysis, e.g., https://en.wikipedia.org/wiki/Inverse-variance_weighting

lutusp10• 13 years ago

Some obvious responses occur to a skeptical reader of science:

1. This study has precisely no meaning until it has been replicated, preferably with a larger set of experimental subjects.

2. Science is not one study making ten claims, it is ten studies making one claim. This study falls into the former category.

3. The study describes, it doesn't try to explain. Science requires a testable explanation, one that can be generalized and potentially falsified by independent laboratories. If the study had offered a possible, testable explanation, it would have crossed the threshold of science.

4. It's important to say that psychological studies are virtually never replicated. One reason is that the original studies tend to maker nebulous claims that are difficult to quantify (like this study does). Another is that psychological studies tend not to be accompanied by the original study data, to a greater extent than studies in scientific disciplines. A third reason is that psychological journals tend to reject replication papers, especially those that don't confirm the original study's findings.

carbocation6• 13 years ago

I was going to write in disagreement with your point #3, but then I went back and re-read the Atlantic article. In that context, I can see why you would write that. However, I think it needs this context, so to others who were going to knee-jerk react to point #3, re-read the article first.

The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be. It's OK that early studies of a phenomenon are not impressive, but the tests do seem to be extremely narrow. The claims should be equally reserved and narrow. I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments.

lutusp10• 13 years ago

> The study is not impressive. Most studies aren't, and exploratory, early-stage studies rarely can be.

Yes, but a longitudinal examination of psychology publications shows that, compared to mainstream science, psychology studies are rarely anything but "early-stage studies". Almost none of them is ever successfully replicated, nor is an effort made to replicate them, compared to other fields.

> I certainly wouldn't start invoking morality, judgment, or other abstractions of the human psyche (as did the author of this article) from such a small and contrived set of experiments.

I of course agree, but then it's a psychology study, where such hand-waving claims are commonplace.

redcircle2• 13 years ago

1. It has lots of meaning before replication, which is why people tend to replicate things --- they were inspired.

2. Apparently the first study isn't science. I didn't realize that science was a catch-22 situation.

3. This is so absurd that I feel like I'm being trolled. They have a testable hypothesis: that acetaminophen/paracetamol has a side effect of X.

4. See https://yourlogicalfallacyis.com/

lutusp10• 13 years ago

> 1. It has lots of meaning before replication ...

Nothing in science has meaning before replication. Look at cold fusion for a classic example where this rule was ignored. Of course, you may be speaking of the prevailing standards in psychology, in which case you're right -- but then psychology isn't a science.

> 2. Apparently the first study isn't science.

That's correct -- it isn't.

> I didn't realize that science was a catch-22 situation.

Only if you can't replicate any studies. That's psychology's problem, but not science's problem. In science, studies are replicated regularly, and no one takes a study seriously if it hasn't been replicated, especially where human health is concerned.

> They have a testable hypothesis: that acetaminophen/paracetamol has a side effect of X.

That is not an explanation, it's a description. Science requires testable explanations. The paper doesn't presume to explain its results.

If I say "the night sky is full of little points of light", that's certainly testable -- someone else can go outside the tent and confirm it, but it's just a description -- not a basis for science, which requires that someone have the nerve to suggest an explanation for what has been described.

But if I say "those points of light are actually thermonuclear furnaces like our sun, at greater distances", I have offered a testable, falsifiable explanation. That's science.

If someone correlated a specific biochemical action in individual neurons with later very specific behavior, that might count as science, but that would be neuroscience, not psychology. Psychology doesn't try to analytically connect specific physical causes to effects -- it's satisfied to describe outcomes without pretending to know why they are so.

> See https://yourlogicalfallacyis.com/

The fallacy is yours, not mine. You appear to think one study making ten claims constitutes science. In fact, science is ten studies making one claim.

jleader2• 13 years ago

Your #1 is false. A single unreplicated study is much less meaningful than several successful replications, but it does have some meaning: "this result looks interesting, someone should try to replicate it and expand it".

If the the first study on any question is completely meaningless, there'd be no motivation to try to replicate it.

Regarding #2, it depends what you mean by "making a claim". A study could test a single hypothesis, validate the hypothesis, and then list 10 things that arguably could follow from that hypothesis. For example, after timing the transit of Mercury and validating relativity, a paper could then in its conclusion list other likely consequences of relativity.

I think a lot of your statements about "science is ..." are confounding a single study with the entire body of scientific progress. Science requires replication and science requires theoretical explanations. That doesn't mean that a single study always has to provide its own replication (it can't!) or theoretical explanation. An experiment that dis-confirms a theory doesn't have to provide an alternative theory in order to be part of science; the theory may come later.

lutusp10• 13 years ago

> Your #1 is false. A single unreplicated study is much less meaningful than several successful replications, but it does have some meaning ...

Not to a scientist. Without replication, a single study is conjecture, interesting but weightless. Are you not aware that an unreplicated study is a standing joke among scientists? Why do you think the gag science journal is named the "Journal of Irreproducibe Results"? Scientists find the name funny because (a) it's an inside joke and (b) it's a truth about science that member of the public just don't get.

http://www.jir.com/

> That doesn't mean that a single study always has to provide its own replication

Then it's a good thing I never said that. But a single study has no standing until and unless a disinterested, independent laboratory succeeds in replicating it.

This issue is so critical to the future of psychology that, after a series of scandals about replication and credibility, a well-known figure in the field has made an emergency call to create replication circles among psychologists to (a) replicate each other's studies, and thereby try to (b) restore public confidence in the field. He says without a replication program, "I see a train wreck looming."

http://www.nature.com/polopoly_fs/7.6716.1349271308!/suppinf... (PDF)

Quote: "For all these reasons, right or wrong, your field is now the poster child for doubts about the integrity of psychological research. Your problem is not with the few people who have actively challenged the validity of some priming results. It is with the much larger population of colleagues who in the past accepted your surprising results as facts when they were published. ... My reason for writing this letter is that I see a train wreck looming."

To see the importance of replication, all you need to do is read the scientific literature.

darkarmani3• 13 years ago

> This study has precisely no meaning until it has been replicated

Why would one replicate it if it has no meaning? Might as well try a new experiment.

D_Alex• 13 years ago

Nice, this needed to be said, have an upvote. But let me talk about point 3. Science has many parts, one large part is gathering observations without even trying to explain - eg. look at the work of 19th century naturalists, who travelled the world collecting drawings of local flora and fauna. Another part is formulating and testing hypotheses based on casual observation which are not yet supported by a theory, and do not really have explanatory powers eg. black men have larger... nostrils.

Quite often an explanation for a hypothesis is found long after the hypothesis itself has been proven correct. Eg: "puerperal fever is a contagious disease (and washing hands helps prevent its transmission)" has been establishd long before the germ theory of disease was even formed.

lutusp10• 13 years ago

> Science has many parts, one large part is gathering observations without even trying to explain ...

Yes, and science requires microscopes and telescopes. But science isn't defined by microscopes and telescopes, it's defined by what scientists do with them. By themselves, these individual elements aren't science, because they don't lead to a falsifiable proposed explanation, the single essential element in the definition of science.

http://en.wikipedia.org/wiki/Falsifiability

Quote: "Simply, to be scientific, a theory must predict at least some observation potentially refutable by observation."

> Quite often an explanation for a hypothesis is found long after the hypothesis itself has been proven correct ...

A hypothesis cannot be "proven correct". That's reserved to theories -- explanations that generalize observations and predict their relevance to phenomena not yet examined.

> "puerperal fever is a contagious disease (and washing hands helps prevent its transmission)" has been establishd long before the germ theory of disease was even formed.

Yes, and shaking a dried gourd over a cold sufferer will cure his cold. Isn't that science? -- it always works! If I visit 1000 cold sufferers and shake my gourd over them, every single one of them will get better if I shake the gourd long enough. So is my procedure science? No, it is not -- because I have not tried to explain why my method works, nor have I considered alternative explanations for my result.

The dried gourd example, and a thousand other examples of sloppy thinking, show that testable, falsifiable explanations are a requirement for science.

vacri2• 13 years ago

Psychology is a scientific discipline, and it's clear you have a chip on your shoulder about the field.

lutusp10• 13 years ago

> Psychology is a scientific discipline

Thomas Insel, the sitting chair of the NIMH, disagrees with you. In his Scientific American article "Faulty Circuits" (http://www.scientificamerican.com/article.cfm?id=faulty-circ...), he says:

"In most areas of medicine, doctors have historically tried to glean something about the underlying cause of a patient’s illness before figuring out a treatment that addresses the source of the problem. When it came to mental or behavioral disorders in the past, however, no physical cause was detectable so the problem was long assumed by doctors to be solely “mental,” and psychological therapies followed suit.

Today scientific approaches based on modern biology, neuroscience and genomics are replacing nearly a century of purely psychological theories, yielding new approaches to the treatment of mental illnesses."

I draw your attention to the phrase "scientific approaches based on modern biology, neuroscience and genomics are replacing nearly a century of purely psychological theories ..."

Science requires empirically testable, falsifiable theories. Psychology doesn't have empirically testable, falsifiable theories. End of story.

tokenadult• 13 years ago

As usual in threads on topics like this, you can rely on HN participant carbocation's comments for some thoughtful perspective on the original article.

As the submitted article notes, responding to the press releases by the study authors,

"This all raises more questions than it answers. This study was small. The headlines are grandiose. The way people pass moral judgements is not necessarily indicative of their level of existential anxiety."

Indeed. This is an intriguing issue to study, and well worth some further studies by other investigators to see if the results will be replicated in other study populations, but the author of the submitted article was correct to have a headline with an open-ended question rather than a definitive statement about Tylenol. On my part, because I take different over-the-counter pain relief medications when I need any of those, I'm curious if this result would be replicated for aspirin or for ibuprofen. That the pain of stubbing a toe and the pain of rejection in love might have some of the same brain mechanisms is suggested by our use of the word "pain" for both phenomena. But that requires further study. (I'm sure there are many studies already on that issue, but I'm not deeply familiar with the research literature on that topic.) That pain (of either kind) might motivate action and thus dulling pain might reduce motivation for some actions is also plausible, and also has surely been investigated before, but perhaps there are still some very basic facts about that issue yet to be discovered. As so often happens after a new study is published, the most firm conclusion is "further research is needed."

rcthompson• 13 years ago

Tylenol has a different mechanism than most other over-the-counter pain relievers. Most other OTC pain relievers are "non-steroidal anti-inflammatory drugs" (NSAIDs), which means that they actually reduce inflammation at the site of injury instead of just reducing the amount of pain that your brain feels (though they do that too). But I still wouldn't be surprised if they had similar emotional effects.

redwood• 13 years ago

Good point. It's hard to see the experience of specific pain as ever existing within a vacuum of human experience.

It's interesting to compare ourselves: a population of pill poppers at the slightest twinge, to those in other parts of the world who simply don't. Perhaps it affords us some extra (or different) mental space in an intangible way.

Alex3917• 13 years ago

"But I still wouldn't be surprised if they had similar emotional effects."

Reducing inflammation tends to reduce anxiety, so the effects would definitely be similar. That said, tylenol also binds to the cannabinoid receptors, albeit weakly, so that may have something to do with the effect there.

elchief• 13 years ago

Why do people take Tylenol, when aspirin/asa is safer and likely even good for you?

DanBC7• 13 years ago

Aspirin is not safer. Aspirin is not "good for you" apart from narrow groups of people taking very small doses of aspirin.

Aspirin can be harmful to the stomach lining; aspirin can be fatal to people under 12; aspirin has a number of risky side effects; aspirin can be very dangerous for some people with under-lying conditions.

parasubvert4• 13 years ago

Thats fear mongering. Aspirin one of the safest drugs known to man, has a much longer history than Tylenol, and some scientists promote a more aggressive use of it in the populace.

http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-...

parasubvert4• 13 years ago

Mainly for three reasons - you may not want an anti-coagulant - you have a sensitive stomach - Tylenol may be safer for breaking a fever due to liver interaction

darkarmani3• 13 years ago

So, you are saying i should switch my kids to aspirin? What's the worst that can happen?

jakobe• 13 years ago

Unfortunately, you can't just claim that Aspirin (ASS) is safer than Tylenol (Paracetamol).

Among the NSAIDs, aspirin is the strongest anti-coagulant, and the anti-coagulation effect can last for weeks. While small doses of ASS are beneficial for people who are at risk for thrombosis, they significantly raise the risk of eg. brain haemorrage.

You could of course take something like ibuprofen, which affects coagulation less. But all NSAIDs attack your stomach, so after some time you'll have to start taking something like pantoprazol to "protect" your stomach...

AFAIK, paracetamol doesn't affect blood clotting and it doesn't attack your stomach. It's dangerous if you take doses of more than 3 gram per day, and you really shouldn't take it if your liver is failing. Alcohol can also cause severe side effects when taking paracetamol.

There is no "perfect drug". If there was a drug that would only have positive effects on our body, evolution would have made our bodies produce that substance on their own.

stcredzero• 13 years ago

> They either watched The Simpsons or a film by surrealistic neonoir writer/director David Lynch, in which humans with rabbit heads wander an urban apartment muttering non sequiturs. They then passed judgement on people arrested in a hockey riot. Again, the people in the existential mindset imposed harsh sanctions, but the people who'd watched The Simpsons were lenient.

I shoulda stuck with psychology after all! This sounds fun! Who thinks of this stuff?

freyrs3• 13 years ago

> in which humans with rabbit heads wander an urban apartment muttering non sequiturs

I don't know how you could sit through this film without already being disturbed.

[1] https://www.youtube.com/watch?v=5jSBVo59j9U

noonespecial• 13 years ago

It should at least be noted that an awful lot of those overdoses are because narcotic painkillers are often doped with paracetamol in a misguided attempt to keep people from using them to get high.

powertower• 13 years ago

> The way people pass moral judgements is not necessarily indicative of their level of existential anxiety.

That actually makes quite a bit of sense...

These days everyone has an opinion on everything, combined with a very judgmental tone - and at the same time living extremely purposeless and egocentric lifes.

Evbn3• 13 years ago

And purpose-driven zealots are not judgmental?

coolestuk3• 13 years ago

Never mind what it is doing for your mind, in my experience, paracetamol causes pain.

I've suffered from what doctors call "pain syndrome" for years. Many different parts of my body are painful at any one time. It is years since I had a pain-free day.

I never accepted that I had pain syndrome, even when doped up simultaneously on codeine, paracetamol, tramadol and diclofenac. And still in pain. Finally I was moved onto morphine, but I still cannot sleep at night because of the pain.

However, I think that my pain problems were exacerbated by (at the very least) paracetamol (max dose daily for 2 years). It is well known that sulphur compounds (NAC specifically) are required for the detoxification of the byproducts of paracetamol. Long term use of paracetamol will lead to sulphur depletion in many people. And it seems this depleted sulphur is compensated by the body taking sulphur from other places (joints, cartilage), thus causing further pains.

Trying to get an answer from doctors and pharamacists about why taking sulphur reduces my pain more than the above concoctions of "pain-killers" got me nowhere, so the above is my explanation for why the more paracetamol I took the worse my pain problems got.

Daniel_Newby• 13 years ago

You should try drugs for neuropathic pain if you have not already: amitriptyline, gabapentin, duloxetine, and many others.

Evbn3• 13 years ago

You should maybe talk to your doctor about these drugs, before just trying them.

coolestuk3• 13 years ago

Thanks for the suggestion. Tried them all. Amitryptyline made me suicidal (turns out that is a very common side-effect, and really unwelcome for someone who is in extreme pain). Gabapentin (and pre-gabalin) had no effect, but at least did not cause mental disturbance the way that Amitryptyline and Duloxetine did. The last one they tried me on was Venlaflaxine - I didn't notice any pain reduction, but I just got insomnia from it.

It's been a bad 5 to 10 years. My opinion is that "pain syndrome" was almost certainly not my problem. My pains were all skeletal/joint pains, except for pains that would suddenly appear in my left hand or right calf, even when doing nothing. Those latter two I could explain as being neuropathic, but after being in so much pain from my back, coccyx, hips and shoulder, I think my pain registration system was out of whack. And I wouldn't be surprised to discover that all the different "pain killers" I was taking were in fact contributing to further problems.

Currently I am just on morphine, but must tie myself to the bed at night to stop myself turning over in my sleep. If I lie on my sides, the pain will build (even through morphine) until it wakes me up. By that stage turning on my back will not reduce the pain and I cannot get back to sleep. Taking a sulphur supplement (NAC, or MSM) seems to be as effective as morphine (neither alone or together is really satisfactory though).

What has been so appalling in my case, has been the difficult of getting doctors to look at the individual problems properly in early stages (so a dearth of scans/treatments), until it got to the point where they were saying "you have pain syndrome". Most of the treatments that have had any success are those that I have insisted they do even when they have said they won't work. Some major treatments I have had to insist they don't do (cutting nerves??).

I'm finally getting a scan this week on my hips, after asking for this for almost 2 years. Hopefully it will show what I expect it to show, and they can treat it with steroids.

jacques_chester• 13 years ago

One possibility is trigger point pain. Try dry needling. It's less woo-y than straight up accupuncture.

guylhem• 13 years ago

I see many post mentionning how Tylenol can be lethal in overdose due to liver damage.

Some studies have demonstrated liver enzymes raise significantly on a typical extra-strength dose of acetaminophen, called paracetamol in Europe. This could be indicative of low-level damage, for casual users (it's frequently prescribed for minor pain)

A quick and simple hack is to take it along with N-acetylcysteine, usually given for coughing.

Personally, to play it safe, when I have to take more than half a gram of paracetamol, or when I have to take it for more than 2 days in a row, I add n-acetylcysteine with it.

Cheap, and without side effets at low doses. (BTW, it's used IV in the ER as the antidote for tylenol overdosing)

gmac• 13 years ago

I'm sure I remember a debate being had in the news at some point about whether this antidote should be included in all paracetamol/acetaminophen pills sold.

Since this seems not to have happened, does anyone know if there's some side-effect of taking N-acetylcysteine alongside paracetamol/acetaminophen as standard? Or was it just a question of price?

zachdonovan• 13 years ago

Well, I for one will be taking two tylenol daily starting to day. You know, to dull the existential angst.

What's Tylenol Doing to Our Minds?

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