Our response to painkillers

[panache45]

Many people swear by Tylenol (acetaminophen). I could take a dozen, and it has no effect on me. My mother was the same way. Also Aleve (naproxen sodium), a popular painkiller that has no effect on me. I understand that people have different body chemistries, but shouldn’t these medications have at least a minimal effectiveness on everyone? What could account for them simply having no effect on some people?

[griffin1977]

A huge part of OTC painkillers is psycosomatic, especially in these days where very little in the way of powerful painkilling agents can be sold OTC.

[Contrapuntal]

@griffin1977

A huge part of OTC painkillers is psycosomatic,

Can I get a cite for that?

[griffin1977]

@Contrapuntal

Can I get a cite for that?

There is a ton out there…

Experiments show that even a placebo achieves a headache relief rate of about 45 percent compared to a relief rate of around 80 percent for actual aspirin. For some people, headaches go away by themselves, or the psychological effect of a placebo is sufficient to relieve their headaches

http://wps.aw.com/aw_carltonper_modernio_4/21/5566/1424976.cw/content/index.html
(Some sites at the bottom of the page I’ve not looked them up).

No figures here(and Ben Goldacre’s website is down, where he lists cites for this kind of thing):

Branding, of course, is the key to the efficacy of little white sugar pills. Marketing, after all, is nothing if not engineered cultural meaning. A four-way comparison among sugar pills and aspirin, in either unbranded aspirin boxes or packaging mocked up to look like the Disprin brand, showed that the brand-name packaging works, because of the huge wealth of cultural background material - the adverts, the word-of-mouth endorsement, the childhood experiences - that packaging plays on. The change in packaging had almost as big an impact on pain as whether the pills actually had any drug in them.

Ben Goldacre: A tonic for sceptics

(EDIT: Just to clarify he’s talking about homeopathy not OTC meds when he refers to “little white sugar pills”, but the evidence he cites is still relevant)

[Contrapuntal]

Well, I’ll poke around some, but your two references are to aspirin, not “OTC painkillers.”

[Qadgop_the_Mercotan]

A relief rate of 45% for placebo is far inferior to a relief rate of 80% for aspirin.

Do you want your cancer treatment to be 45% or 80% likely to be effective?

Pain’s a complex topic, and if I start rambling about it here, I’ll end up writing another essay (that’ll cause people to type “TLDR”), or another academic presentation (that’ll cause my colleagues to yell “you told us this stuff already, and we already knew it then”).

But suffice it to say that repeated solid studies have shown that overall, both NSAIDS (aspirin, ibuprofen and others) and APAP (tylenol, acetaminophen) do have bona fide mechanisms that are fairly well understood, and are effective for reducing some sorts of pain across the board.

Now individual mileage varies greatly, and depending on the types of pain (physical, with its myriad of further subtypes; psychological; emotional; spiritual) combining to cause the distress, different people’s results will vary widely.

[Harriet_the_Spry]

Although this article is about antidepressants, not painkillers, it may be of interest. It is about a relatively new genotyping test that tells how your liver breaks down medications.

Cytochrome P450 (CYP450) tests - Mayo Clinic

Another factor, speaking from my experience, is that the type of pain matters. Tylenol works well for me for dental pain or headaches but is not particularly helpful for crampy pain-the NSAID painkillers help me more with that. I think that is because of their anti-inflammatory effects.

[griffin1977]

@Qadgop_the_Mercotan

A relief rate of 45% for placebo is far inferior to a relief rate of 80% for aspirin.

But it still represents a “huge” part of the overall effect. I never claimed they had no effect, Also note that the second study I quoted showed that the PACKAGING of Aspirin had MORE effect than whether the package actually contained Aspirin or not!

[Nancarrow]

@panache45

I could take a dozen, and it has no effect on me.

:eek:

It certainly would have an effect on your liver.

[Markxxx]

I think a lot of painkillers are psychological. I almost never get headaches, maybe one or two a year, and if I do Tylenol takes care of it the best. But cause I work out a lot, for minor aches and pains nothing is better, for me, than aspirin. And if I have a toothache, Ibuprofen works better than asprin or Tylenol.

Of course Orudis works the best for me, but I can’t find it over the counter and online you can get it but it’s way too much money.

[aruvqan]

I can remember hearing about how wonderful aleve was - an absolute miracle, 2 little blue pills for all day …

About as effective as little blue M&Ms without the chocolate.

Then I complained to the doctor, and found out that apparently I don’t have the right genetics for it to work on me …

I have absolutely baffled new doctors, who want to give me the script strength and I ask for ibuprofin instead … but at least I know motrin works on me.

I also baffle them because I will ask for motrin in place of anything with codeine in it, as it doesnt seem to do anything for me either … though once I took enough codeine to get constipated - and it still didn’t work other than to constipate me

I have a feeling that I am going to ask for vicodin for my hysterectomy tuesday. I know that will work. From what I remember about my last lap cutting, the pain was fairly minimal, and this is going to be a Da Vinci, and supposedly not too much worse than the basic lap. If it isn’t going to be too much worse, then vicodin will work perfectly.

[Gfactor]

Zombie! :eek: