May 16, 2016
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Friday the 13th has come and gone, but there are still a lot of psychopaths in my house. Well on the TV anyway. Emily likes Criminal Minds re-runs. There is a reboot of Alfred Hitchcock's Psycho called Bates Motel that Doris is into. For a while I watched Dexter. The main character is a serial killer, but during the day he works in police forensics. And at night he only kills bad guys. Pretty much the definition of an anti-hero. Apparently there are psychopaths in real life, but they aren't the blood thirsty type. Getting a true psychopath diagnosis is complicated and needs to be done by a mental health professional. But one of the hallmarks of psychopathy, is a lack of empathy. Among other things, psychopaths can't feel the emotional pain of others.
I get asked about physical pain in the pharmacy all the time. A common question is, "What is the best pain killer?" That is a harder to answer than you would think. Strong narcotics like hydromorphone are some of the most effective pain killers we have. But the strong narcotics also have a bucket full of side effects. And curiously, they might work if you have pain from a broken bone, but they might not touch nerve pain like sciatica. A medication like gabapentin, which isn't even really a pain killer, might work better on nerve pain. You see it's complicated. But if you ask most doctors or pharmacists what the safest pain killer is, I think they'd all have the same answer. Acetaminophen is arguably the safest pain killer we have. We use it in infants. We use it in the elderly. We use it in pregnant women.
For a medication as well studied as acetaminophen, it is surprising we don't know exactly how it works. We know it work in the brain to reduce pain and fever. We just are uncertain exactly which enzymes and chemicals it works on to do this. Unlike the non-steroidal anti-inflammatories or NSAID's, acetaminophen reduces pain, reduces fever but doesn't treat inflammation.
There are interesting misconceptions about acetaminophen that I hear in the pharmacy. I often hear that people say acetaminophen is dangerous to their kidneys. It isn't. Acetaminophen taken in is recommended doses is not hard on the kidneys. We put people with kidney problems acetaminophen instead of ibuprofen, naproxen or ASA. That is because NSAID's like ibuprofen, naproxen or ASA can be hard on the kidneys in some cases.
Many people have said that, "Acetaminophen or tylenol makes me constipated." This one has always boggled me. There are always a few people who have unusual reactions to medications, but people tell me this one a lot. Acetaminophen doesn't bother the stomach or colon. That is another reason we use it so often. NSAID's can cause ulcers and bleeding in the stomach. Acetaminophen doesn't do that. The only other reason I can think of that people talk about acetaminophen and constipation is the confusion between Tylenol and Tylenol #3. Tylenol just has acetaminophen in it. Plain Tylenol shouldn't cause constipation. Tylenol #3 has acetaminophen, caffeine and codeine in it. Codeine can definitely cause constipation, so people on Tylenol #3 can get constipated.
The two groups we have to be the most careful with acetaminophen is in the very old and the very young. In children, it can be easy for a parent to accidentally overdose a child with acetaminophen. You have to be very careful to read the labels on the medications, and if you have any questions, call your pharmacist. But other than mis-reading labels, parent can run into the problem that multiple products can all have acetaminophen in them. For example, an allergy medication, a cough syrup and a fever medication might all have acetaminophen in it. Even if the parent gives the child the right dose of all three medications, that means they are giving the child 3 times as much acetaminophen as they should be.
In the elderly, often acetaminophen is given every day for pain. That can be very reasonable as acetaminophen is very safe. But recently the maximum dose for long term use in the elderly was dropped from 4 grams or 8 tablets of tylenol extra strength per day to 3 grams or 6 tablets of tylenol extra strength per day. So again, read the labels and talk to your pharmacist.
As I clicked through the Huffington Post, I saw an article that talked about Tylenol and empathy. Baldwin Way et. al published an article in Social, Cognitive and Affective Neuroscience, where they gave some test subjects Tylenol and others placebo. The researchers claimed that the ones on acetaminophen reacted less strongly when told of another person's misfortune. The researchers claim that taking acetaminophen makes you less empathetic. This seems like a bit of a stretch. With up to a quarter of North Americans taking acetaminophen every week, this supposed empathy dulling effect should be creating a lot more psychopaths. I can't wait until someone blows this tiny study completely out of proportion, and scares people away from this very safe pain killer. The headline will say acetaminophen use is why psychopaths are so popular on TV in my house. Tylenol has destroyed our capacity for empathy, and we are just trying to find kindred spirits.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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Huffington Post: Common Pain Killer Dulls Emotions: http://www.huffingtonpost.ca/2016/05/11/tylenol-emotions_n_9904818.html
psychopath explanations https://www.psychologytoday.com/basics/psychopathy
Bates Motel - http://www.aetv.com/shows/bates-motel