Can Acetaminophen reduce empathy in patients ?

Introduction

If your job (mindset) depends on feeling empathy for others, you should reconsider reaching acetaminophen when you have a headache.

Acetaminophen, commonly known by the trade name Tylenol, is an ingredient in more than 600 prescription and over-the-counter medicines.

It offers quick relief from mild pain and is readily available over the counter.

The medical community considers acetaminophen to be a relatively safe and useful drug. Still, a recent study asks whether it might have an unexpected effect on large population.

The popular painkiller blunts physical pain by reducing the flow of chemicals that is responsible for making nerve endings sensitive. However, the recent study finds that the chemicals keep on circulating in regions of the brain that control empathy and compassion.

The study warns people from taking paracetamol before having an emotional conversation. Moreover it states that it blocks a person’s ability to empathise.

What does Dominik Mischkowski say about acetaminophen ?

Dominik Mischkowski, a psychologist at Ohio University, believes paracetamol, or acetaminophen, warp people’s personalities by dulling their emotions.

He said ‘just like we should be aware that you shouldn’t get in front of the wheel if you’re under the influence of alcohol, you shouldn’t take paracetamol and then put yourself into a situation that requires you to be emotionally responsive – like having a serious conversation with a partner or co-worker. When you give somebody a drug, you don’t just give it to a person – you give it to a social system.’

He also said the public should be more aware of its sinister side-effect so they can use ‘common sense’ to decide when to take it.

Mischkowski further added that they do not know the effects of these medications in the broader context. Futhermore, adding that “when it comes to the effects of medication on personality and behaviour… we don’t understand how they influence human behaviour.”

MRI scans have shown activity ramps up in certain brain areas when experiencing ‘positive empathy’ – pleasure on other people’s behalf – and when we’re in pain.

Previous research studies

Although a popular analgesic might have a psychological effect seems surprising, Mischkowski is not the only person who investigated it.

For instance, a 2010 paper concluded that acetaminophen “reduced neural responses to social rejection.” In other words, it appeared to reduce psychological pain.

A study from 2015 concluded that acetaminophen blunted “evaluative and emotional processing”. While a more recent study involving people with borderline personality disorder found that acetaminophen increased their level of trust.

In research published online in the journal Social Cognitive and Affective Neuroscience, scientists from the National Institutes of Health and Ohio State University describe the results of two experiments they conducted involving more than 200 college students.

“We don’t know why acetaminophen is having these effects, but it is concerning,” senior author Baldwin Way, an Ohio State psychologist, said in a statement. “Empathy is important. If you join an argument with your spouse after taking acetaminophen, this research suggests you might empathise with spouse’s feelings.”

The two experiments

In the first experiment, they asked 80 participants to drink a liquid. Half the subjects received something containing 1,000 mg of acetaminophen. The other half got something without the drug. After an hour, they asked all subjects to rate the pain experienced by characters in eight different fictional scenarios. In some of the stories, the character went through a physical trauma, in others an emotional trauma. In general, those subjects who took acetaminophen rated pain of the characters as less severe than those who took placebo.

A second experiment exposed participants to brief blasts of painful noise. The team then asked the participants to rate the pain of another (anonymous) study participant the team also subjected to the unpleasant sounds. Again, those who received acetaminophen rated the other person’s pain as less severe compared to students who drunk placebo liquid.

As a further test, in which participants had to judge online skits involving social rejection, they split along the same lines as in the noise experiment.

Results of the two experiments

“In this case, the participants had the chance to empathise with the suffering of someone who they thought was going through a socially painful experience,” Way said. “Still, those who took acetaminophen showed a reduction in empathy. They weren’t as concerned about the rejected person’s hurt feelings.”

The two experiments build on previous studies identifying a brain region that appears to be key to a person’s empathetic response. Located deep in folds between front and side of the brain is anterior insula where mind and body are integrated. It also plays a key role in human awareness, including emotional awareness. The less pain a person feels, the less able he or she is to empathise with someone else’s.

“Because empathy regulates prosocial and antisocial behavior,” the authors note, “these drug-induced reductions in empathy raise concerns about the broader social side effects of acetaminophen.”

Research studies by Mischkowski

Mischkowski published the findings of a study in 2016. In the paper, the researchers explained how acetaminophen seemed to reduce participants’ ability to empathize with those undergoing physical and emotional suffering.

In his latest study, Mischkowski wanted to expand on his previous work. Specifically, he set out with his colleagues to explore whether acetaminophen might also reduce someone’s ability to experience positive empathy.

He investigated the behavioral effect of paracetamol in a study of 114 students from Ohio University.

They split volunteers into two groups, with one half receiving a 1,000mg dose of paracetamol – two large tablets – while they gave other a placebo.

After an hour they then read scenarios about uplifting experiences that had happened to other people.

One example was good fortune of ‘Alex’, who secured date with his crush after getting ready to ask her out.

Participants rated how much pleasure they themselves were experiencing while reading the scenarios. And how much empathy they had for people in them.

The results revealed that people who took the drug felt significantly less positive empathy.

While the study did not look at negative empathy – when people feel pain for others. Mr Mischkowski said the principles were the same.

He described his research earlier this year as the ‘most worrisome that he’s ever conducted’.

The researcher admits the drug is not constantly hijacking people’s personalities, because the effects only last a few hours.

Shortcomings in Mischkowski’s latest study

There are a number of ways in which researchers could strengthen the study. For instance, inducing empathy in real-life situations would be preferable to merely reading emotive texts.

It is also worth noting how difficult it is to quantify empathy or any other human emotion for that matter. In this particular study, the team asked the participants to rate the extent to which they felt, for instance, pleasure, uplifted, or pleased, using a five-point scale from “not at all” to “extremely.”

Using an individual’s self-rating is problematic for several reasons. For example, it could be that participant was not experiencing decreased empathy but a reduced desire to share their feelings.

That said, even if acetaminophen does not alter empathy, it appears to lead to a measurable change in the way that participants respond to a questionnaire, which is still interesting.

Conclusion

These findings contribute to a growing body of similar research. Conversely, most of the studies are small-scale and generally involve fewer than 100 participants. So, although interest is growing, it is yet impossible to gauge size of acetaminophen’s effect on empathy, if it exists.

It may be that this effect is small or that the drug only affects some people. But due to the widespread use of this pain reliever, even a small effect could be significant.

Dominik Mischkowski also said,”given that an estimated quarter of all U.S. American adults consume a drug containing acetaminophen every week, this research really matters.”

The idea that such a common medication could cause a psychological effect, even if it is subtle, is intriguing. However, few studies have addressed these questions. And scientists will need to do much more detailed work before we can conclude that acetaminophen reduces empathy in a meaningful way.