Monday, July 13, 2009

Why the #$%! Do We Swear? For Pain Relief: Scientific American

Bad language could be good for you, a new study shows. For the first time, psychologists have found that swearing may serve an important function in relieving pain.

The study, published today in the journal
NeuroReport, measured how long college students could keep their hands immersed in cold water. During the chilly exercise, they could repeat an expletive of their choice or chant a neutral word. When swearing, the 67 student volunteers reported less pain and on average endured about 40 seconds longer.

Although cursing is notoriously decried in the public debate, researchers are now beginning to question the idea that the phenomenon is all bad. "Swearing is such a common response to pain that there has to be an underlying reason why we do it," says psychologist
Richard Stephens of Keele University in England, who led the study. And indeed, the findings point to one possible benefit: "I would advise people, if they hurt themselves, to swear," he adds.

How swearing achieves its physical effects is unclear, but the researchers speculate that brain circuitry linked to emotion is involved. Earlier studies have shown that unlike normal language, which relies on the outer few millimeters in the left hemisphere of the brain, expletives hinge on evolutionarily ancient structures buried deep inside the right half.

One such structure is the amygdala, an almond-shaped group of neurons that can trigger a fight-or-flight response in which our heart rate climbs and we become less sensitive to pain. Indeed, the students' heart rates rose when they swore, a fact the researchers say suggests that the amygdala was activated.

That explanation is backed by other experts in the field. Psychologist
Steven Pinker of Harvard University, whose book The Stuff of Thought (Viking Adult, 2007) includes a detailed analysis of swearing, compared the situation with what happens in the brain of a cat that somebody accidentally sits on. "I suspect that swearing taps into a defensive reflex in which an animal that is suddenly injured or confined erupts in a furious struggle, accompanied by an angry vocalization, to startle and intimidate an attacker," he says.

But cursing is more than just aggression, explains
Timothy Jay, a psychologist at the Massachusetts College of Liberal Arts who has studied our use of profanities for the past 35 years. "It allows us to vent or express anger, joy, surprise, happiness," he remarks. "It's like the horn on your car, you can do a lot of things with that, it's built into you."

In extreme cases, the hotline to the brain's emotional system can make swearing harmful, as when road rage escalates into physical violence. But when the hammer slips, some well-chosen swearwords might help dull the pain.

There is a catch, though: The more we swear, the less emotionally potent the words become, Stephens cautions. And without emotion, all that is left of a swearword is the word itself, unlikely to soothe anyone's pain.

Friday, July 10, 2009

Pain Resource Centre

The Pain Resource Centre is designed to be a centralized resource
about pain and pain management for Canadians.

The PRC is a place on the web where people can obtain reliable
information about pain so that they can help themselves, their
clients, their family members, friends, and co-workers.

The Canadian Pain Coalition and the Education Special Interest Group
of the Canadian Pain Society have developed the Pain Resource Centre
to provide information to the Canadian public and to health care
professionals in Canada with regard to the treatment and management
of pain. In making information about pain available to individuals
who live with pain our objective is to enable such individuals to
work more effectively with their health care providers to manage
their pain more effectively.

Tuesday, July 07, 2009

Reasons Not to Panic Over a Painkiller -

Few drugs are more ubiquitous than acetaminophen, the pain reliever found in numerous over-the-counter cold remedies and the headache drug Tylenol.

But last week, a federal advisory committee raised concerns about liver damage that can occur with overuse of acetaminophen, and the panel even recommended that the Food and Drug Administration ban two popular prescription drugs, Vicodin and Percocet, because they contain it.

The news left many consumers confused and alarmed. Could regular use of acetaminophen for pain relief put them at risk for long-term liver damage?

To help resolve the confusion, here are some questions and answers about acetaminophen.

What prompted the committee to look at acetaminophen in the first place?

Every year about 400 people die and 42,000 are hospitalized as a result of acetaminophen poisoning. When used as directed, the drug is not hazardous. But acetaminophen is now in so many products that it is relatively easy to take more than the recommended daily limit, now four grams.

"People often don't know what products acetaminophen is in," said Dr. Lewis S. Nelson, a medical toxicologist from New York University who was the panel's acting chairman. "It isn't that hard to go above the four-gram dose. If you took a couple acetaminophen for a headache until you got to the maximum dose, and then maybe later you take Tylenol PM and some Nyquil for a cold. And your back hurts, so you take Vicodin — by now you've probably gotten to a seven-gram dose."

What did the panel recommend?

Besides a ban on Percocet and Vicodin, it called on the F.D.A. to lower the total recommended daily dose of acetaminophen from the current level of four grams, which is about 12 tablets of regular strength Tylenol. The new maximum dose is likely to be 2.6 to 3.25 grams, equal to 8 to 10 regular pills.

The panel also recommended that "extra strength" doses — equal to two 500-milligram pills — be switched to prescription only, and that the largest dose available over the counter be limited to two 325-milligram pills. It also recommended that infants' and children's doses be standardized to prevent errors.

As a precaution, should consumers switch to other types of over-the-counter pain relief?

Emphatically, no. Every drug has risks and side effects, but over all the risk of acetaminophen to any individual is low. Far more people are harmed by regular use of aspirin and ibuprofen, which belong to a class of medicines called nonsteroidal anti-inflammatory drugs, or Nsaids. By most estimates, more than 100,000 Americans are hospitalized each year with complications associated with Nsaids. And 15,000 to 20,000 die from ulcers and internal bleeding linked to their use.

By comparison, there are only about 2,000 cases of acute liver failure, and about half of them are related to drug toxicity. Of the drug-induced cases, 40 percent are due to acetaminophen, and half of those are a result of intentional overdose.

"Nearly everybody on the panel recognizes that from a public-health perspective, ibuprofen is much more concerning than acetaminophen," Dr. Nelson said.

For users of Percocet and Vicodin, the picture is cloudier. Hydrocodone, the narcotic in Vicodin, is not available as a single drug. Oxycodone, the narcotic in Percocet, will remain available. But these ingredients are tightly controlled, and prescriptions may require extra time and paperwork.

If I've been using a drug like Vicodin, should I be worried about long-term liver damage?

The risks associated with acetaminophen overdose are acute or immediate liver failure, not chronic liver disease. Even if you've been taking Tylenol or other drugs with acetaminophen for years, there is no reason to worry about long-term liver damage as long as you are using them as directed. (By comparison, regular use of Nsaids like aspirin and ibuprofen can lead to chronic gastrointestinal problems over time.)

An overdose of acetaminophen does not typically produce immediate symptoms. Instead, drug-induced hepatitis is likely to develop within a week, leading to loss of appetite, nausea, vomiting, fever and abdominal pain. Dark urine and jaundice (yellowing of the skin and eyes) suggest a more serious case. Usually the liver will recover once the drug is stopped or with medical treatment, but many patients in acute liver failure will die without a transplant.

About 15 percent of liver transplants result from drug poisoning. In one study, 40 percent of drug-related liver transplants were due to acetaminophen, 8 percent to tuberculosis drugs, 7 percent to epilepsy treatment and 6 percent to antibiotics.

What's the main lesson from the panel review of acetaminophen?

Because acetaminophen is in so many products, consumers need to be vigilant about reading labels, and they need to keep track of how much of the drug they are ingesting daily.

"It would be a real shame if people in reading these stories got the idea that acetaminophen is not safe," said Dr. Paul Watkins, director of the Institute for Drug Safety Sciences at the Hamner Institutes and the University of North Carolina. "It's totally safe when taken as directed. The problem is that people end up unknowingly taking much more than recommended."

Thursday, July 02, 2009

Less Empathy Toward Outsiders: Brain Differences Reinforce Preferences For Those In Same Social Group

An observer feels more empathy for someone in pain when that person is in the same social group, according to new research in the July 1 issue of The Journal of Neuroscience.
The study shows that perceiving others in pain activates a part of the brain associated with empathy and emotion more if the observer and the observed are the same race. The findings may show that unconscious prejudices against outside groups exist at a basic level.
The study confirms an in-group bias in empathic feelings, something that has long been known but never before confirmed by neuroimaging technology. Researchers have explored group bias since the 1950s. In some studies, even people with similar backgrounds arbitrarily assigned to different groups preferred members of their own group to those of others. This new study shows those feelings of bias are also reflected in brain activity.
"Our findings have significant implications for understanding real-life social behaviors and social interactions," said Shihui Han, PhD, at Peking University in China, one of the study authors.
Other recent brain imaging studies show that feeling empathy for others in pain stimulates a brain area called the anterior cingulate cortex. Building on these results, the study authors tested the theory that these empathic feelings increase for members of the same social group. In this case, the researchers chose race as the social group, although the same effect may occur with other groups.
The researchers scanned brains areas in one Caucasian group and one Chinese group. The authors monitored participants as they viewed video clips that simulated either a painful needle prick or a non-painful cotton swab touch to a Caucasian or Chinese face. When painful simulations were applied to individuals of the same race as the observers, the empathic neural responses increased; however, responses increased to a lesser extent when participants viewed the faces of the other group.
Martha Farah, PhD, at the University of Pennsylvania, a cognitive neuroscientist and neuroethicist who was not affiliated with the study, says learning how empathic responses influence our behavior in many different situations is interesting both practically and theoretically. "This is a fascinating study of a phenomenon with important social implications for everything from medical care to charitable giving," she said.
But the finding raises as many questions as it answers, Farah said. "For example, is it racial identity per se that determines the brain's empathic response, or some more general measure of similarity between self and other?" she said. "What personal characteristics or life experiences influence the disparity in empathic response toward in-group and out-group members?"

Wednesday, July 01, 2009

Ban Is Advised on 2 Top Pills for Pain Relief -

A federal advisory panel voted narrowly on Tuesday to recommend a ban on Percocet and Vicodin, two of the most popular prescription painkillers in the world, because of their effects on the liver.

The two drugs combine a narcotic with acetaminophen, the ingredient found in popular over-the-counter products like Tylenol and Excedrin. High doses of acetaminophen are a leading cause of liver damage, and the panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect.

Acetaminophen is combined with different narcotics in at least seven other prescription drugs, and all of these combination pills will be banned if the Food and Drug Administration heeds the advice of its experts. Vicodin and its generic equivalents alone are prescribed more than 100 million times a year in the United States.

Laureen Cassidy, a spokeswoman for Abbott Laboratories, which makes Vicodin, said, "The F.D.A. will make a final determination and Abbott will follow the agency's guidance."

The agency is not required to follow the recommendations of its advisory panels, but it usually does.

The panel's 20-17 vote to recommend a ban on the combination drugs was one of 11 it took at a meeting called to advise the F.D.A. on problems arising from the extraordinary popularity of acetaminophen. In 2005, American consumers bought 28 billion doses of products containing the ingredient.

While the medicine is effective in treating headaches and reducing fevers, even recommended doses can cause liver damage in some people. And more than 400 people die and 42,000 are hospitalized every year in the United States from overdoses.

In hopes of reducing some of these accidents, the committee voted 24 to 13 to recommend that the F.D.A. reduce the highest allowed dose of acetaminophen in over-the-counter pills like Tylenol to 325 milligrams, from 500. And members voted 21 to 16 to reduce the maximum daily dosage to less than 4,000 milligrams.

But they voted 20 to 17 against limiting the number of pills allowed in each bottle, with members saying such a limit would probably have little effect and could hurt rural and poor patients. Bottles of 1,000 pills are often sold at discount chains.

"We have no data to show that people who overdose shop at Costco," said Dr. Edward Covington, a panel member from the Cleveland Clinic Foundation.

Dr. Lewis S. Nelson, a toxicologist from the New York University School of Medicine who served as the panel's acting chairman, said experts had been warning of the dangers of combination painkillers like Percocet, which is made by Endo Pharmaceuticals, and Vicodin for years.

Still, the recommendation is likely to come as a shock to many patients, who may be unaware of the dangers of high doses of acetaminophen — even if they know the drugs contain the ingredient.

Some doctors already avoid prescribing pills that combine acetaminophen with narcotics like oxycodone (found in Percocet) and hydrocodone (in Vicodin).

"It ties the doctor's hands when you put the two drugs together," said Dr. Scott M. Fishman, a professor of anesthesiology at the University of California, Davis, and a former president of the American Academy of Pain Medicine. "There's no reason you can't get the same effect by using them separately."

Dr. Fishman said the combinations were prescribed so often for the sake of convenience, but added, "When you're using controlled substances, you want to err on the side of safety rather than convenience."

Still, some doctors predicted that the recommendation would put extra burdens on physicians and patients.

"More people will be suffering from pain," said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. "More people will be seeing their doctors more frequently and running up health care costs."

In a statement, Johnson & Johnson, Tylenol's maker, said it "strongly disagrees" with the proposed restrictions on acetaminophen, adding that they would be likely to "lead to more serious adverse events as consumers shift to other over-the-counter products," like Advil and aspirin.

Linda A. Suydam, president of the Consumer Healthcare Products Association, said the committee had ignored studies showing that doses sold by her members — two pills of 500 milligrams, up to four times a day — were safe. "I think this is a very effective dose and one needed for individuals who experience chronic pain," she said.

The committee also turned its attention to over-the-counter children's medicines containing acetaminophen, voting 36 to 1 to limit them to a single formulation. Right now the liquids are sold in two different concentrations, leading to confusion among doctors and parents.

"I don't think it's safe to have two formulations out there," said Dr. Nelson, the acting chairman.

The members were divided over which formula to recommend, the concentrated or the less concentrated one. F.D.A. officials suggested that they would likely settle on the less concentrated formula so that if parents make a mistake, they would be less likely to overdose.

Acetaminophen is included in a vast array of over-the-counter cough and cold products, including Nyquil, Excedrin and many others. A small share of accidental poisonings result when people take two or more of these combination products without understanding the risk.

The F.D.A. asked the committee whether it should ban combination products that include acetaminophen. The vote was 24 to 13 against such a ban, with many members saying consumers saw the products as valuable.

"Based on the data provided, the combination O.T.C. medications really contributed very little to overall poisonings," said Dr. Osemwota A. Omoigui, a panel member from the Los Angeles Pain Clinic.

A 2005 study found that most poisonings resulted from patients' taking Vicodin and similar products that combine a narcotic with acetaminophen.

"I think this is the one place where we can engineer in safety," said Dr. Judith M. Kramer, a panel member and an associate professor of medicine from Duke University Medical Center who voted to ban the combination prescription medicines. "We're here because there are inadvertent overdoses that are fatal, and this is our one opportunity to have a big impact."

Consumers need to be better educated about the risks of popular medicines, most panel members agreed.

"If you keep track of what you're taking, none of this is an issue for you," Dr. Jan Engle, a panel member and head of the Department of Pharmacy Practice at the University of Illinois in Chicago, said in an interview after the meeting.