The psychology of pain relief medicine

The manufacturer of a leading brand of painkiller has been accused of misleading customers in Australia.

The manufacturer of a leading brand of painkiller has been accused of misleading customers in Australia.

But how do people choose over-the-counter pain relief?

There’s a whole range of Nurofen products. There are Nurofen capsules, caplets and “meltlets”. Some are marketed to treat specific problems – Nurofen Migraine Pain or Nurofen Tension Headache.

But Nurofen maker Reckitt Benckiser has been ordered to take some of these “specific pain” products off the shelves in Australia. A court decided they were misleading consumers because the packaging made it seem as though they had been formulated to treat different types of pain. In fact, these products contained the same active ingredient – 342mg of ibuprofen lysine.

Reckitt Benckiser says that they are just meeting demand. They argue that 88% of people look for relief for a specific type of pain. Packaging tablets with clear labels saying “back pain” or “period pain” makes it easier for people to decide which one to get to meet their needs, they add.

But take this scenario. A customer has a packet of Nurofen Migraine Pain in their handbag. They suffer a tension headache. They buy Nurofen Tension Headache. By the Australian court’s view they are completely wasting their money – it’s fundamentally the same medicine in different packaging.

All of these specific pain versions cost about double the price of Nurofen’s standard version in Australia. The formulations used in Nurofen’s specific pain range in Australia contain lysine and sodium. The manufacturer says that this allows them to be absorbed faster than the standard version.

In the UK, similar medication is sold. Nurofen Migraine Pain and Nurofen Tension headache caplets have identical active ingredients. They contain the same 342mg of ibuprofen lysine that is in the Australian versions. But no legal action has been taken against Nurofen in the UK.

When someone swallows a general painkiller such as ibuprofen it’s distributed around the whole body through the bloodstream, says Farrah Sheikh, a GP from Greater Manchester. Painkillers targeting specific areas will treat the areas in pain but they cannot be sent directly to a particular part of the body, Sheikh suggests.

The discrepancy in price between different versions of branded painkiller is arguably no stranger than the variation in price between brands like Nurofen, and the generic equivalents that sit near by them on supermarket shelves. Somebody could walk into a Tesco in the UK and spend £2 on a packet of 16 Nurofen when a packet of 16 generic ibuprofen tablets – an identical drug – is just 30p.

The same situation exists in the US. Some people consistently choose Advil (ibuprofen), Tylenol (paracetamol) and Bayer aspirin rather than cheaper versions.

But a study found that people with higher levels of knowledge – for examples doctors and pharmacists – were much less likely to buy branded medicine over generics.

“You’re paying for the marketing essentially and the shiny box,” argues Sheikh. She tends to recommend using cheaper generic painkillers, but says that many of her patients are still loyal to certain brands.

The placebo effect could help explain this. “Just knowing that you’ve taken something can make you feel better,” explains Sheikh. Believing in a particular brand can also have a big impact.

In a recent study, researchers gave people with frequent headaches a dummy pill. Some of these placebos were packaged as branded painkillers and some weren’t. The branded ones were reported to be more effective at pain relief by those in the study and were associated with fewer side effects than the placebos packaged as generic medication.

Which painkiller is best?

Paracetamol: Used to treat headaches and most non-nerve pains, side effects are not common and this dose can be taken regularly for long periods, but overdosing can cause serious side effects; if the pain lasts for more than three days, see your GP
Ibuprofen: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, seem to work better for arthritis or an injury. They should not be used for a long period unless you have inflammation. If you take them for long periods, there’s an increased risk of stomach upset, bleeding, and kidney and heart problems
Aspirin: Produces the same type of side effects as other NSAIDs, but is not as effective as a painkiller, which means it’s not usually prescribed for pain – dangerous for children under 16.

In the UK the colours of the pain killing tablets are different.

Tesco makes its generic ibuprofen silver to match the Nurofen packaging. Its generic aspirin is yellow, the same as Anadin Original. Its generic paracetamol is blue, the same as Panadol’s original paracetamol packaging. In other shops ibuprofen is typically red.

Colours also have an effect on how people feel about the medicine they are taking. Red pills have been reported to be more effective for treating pain than blue, green or white pills. But blue pills make more effective tranquilisers than red ones, except for Italian men. It’s been suggested this could be because blue is associated with their national football team.

Strong colours might help a product stand out from a crowded aisle. But it also pays to have lots of different formulations so that a brand can get as much shelf space as possible.

Even the supermarkets have tried the “specific pain” branding. Sainsbury’s had “migraine relief” and also “tension headache relief” – both 342mg ibuprofen lysine tablets – placed on shelves next to their Nurofen counterparts. The latter is now no longer sold. Anyone taking both in the same day for different types of headaches would have to be aware – for safety reasons – that they are the same drug.

The type of formulation can make a difference for treatment, says the Proprietary Association of Great Britain (PAGB). The body represents manufacturers of over-the-counter medicines, says that this can be the case even if products contain the same active ingredient.

“Sometimes manufacturers make things that are long acting so that the medicine works over a longer period of time,” explains Neal Patel, a pharmacist from the Royal Pharmaceutical Society. This could give someone hours of pain relief so that they can get some sleep. A quick-acting painkiller on the other hand, could be especially useful for people with migraines.

It’s also possible that one type of tablet might be better tasting or easier to swallow than another while still being the same drug.

But the power of the placebo effect is hugely significant. “It’s very powerful. If someone trusts something then it’s more likely to work for them,” says GP Sarah Jarvis. Some of her patients with chronic pain have refused prescriptions because they would rather buy their own brand of painkillers.

Ibuprofen was discovered in 1961. It has joined aspirin and paracetamol in the special trinity of medicines that people keep close at hand, even when they’re well.

 

 

Share of life in fit healthy lives are rising

The proportion of life spent in good fit, healthy lives are increasing in England, even as life expectancy continues to rise.

The proportion of life spent in good fit, healthy lives are increasing in England, even as life expectancy continues to rise.

The research compared two identical surveys, 20 years apart, that measured the health of people aged 65 or older in Cambridge, Newcastle and Nottingham.

The data, collected in 1991 and 2011, involved more than 15,000 responses.

Experts say the findings are encouraging, but warned they suggest health inequalities remain in the UK.

New health threats – such as obesity – may have an impact on wellbeing in the future, which needs investigating, say the researchers.

The work, part-funded by the Medical Research Council and published in The Lancet, looked at three measures of good health:

self-perceived health
time free from cognitive impairment (dementia)
life without disability

In 2011, men spent nearly four more years and women about three more years in “self-reported” good health compared with the respondents in the 1991 survey.

The chance of having dementia also appeared to be reduced in the 2011 group – men and women enjoyed about four more years free of any cognitive impairment compared with those surveyed in 1991.

Life without disability gains between 1991 and 2011 were smaller – 2.6 years for men and half a year for women, on average – and there was a mixed picture. While severe disability became less common between 1991 and 2011, milder disability increased.
Image copyright Thinkstock

The researchers say the milder disability figures might be explained by rising rates of obesity and arthritis.

But, overall, they say their findings are positive.

Lead researcher Prof Carol Jagger, from Newcastle University, said: “Brain health has improved over the 20-year period. We’re not entirely sure why.”

Although, as individuals, people may be living more years without cognitive impairment, Prof Jagger said, it was important to remember the number of cases of dementia in the UK was still rising because of an ageing population – there were more elderly people living in the country, meaning more “at risk”.

“Our findings have important implications for government, employees and individuals with respect to raising the state pension age and extending working life,” she said.

“It is also necessary for community care services and family carers who predominantly support those with mild to moderate disability to enable them to continue living independently.”

Caroline Abrahams, charity director at Age UK, said: “Real improvements in older peoples’ health are a real cause for celebration and demonstrate the continuing importance of supporting people to age well, especially through the provision of good quality health and social care services.”

“However, we know that health inequalities are still deeply entrenched across the UK and with a growing older population, particularly of those aged over the age of 85, there is still much more work to do to help every older person have a healthier and happier later life.”

 

 

 

Man’s weight affects sperm cells

A man’s weight affects the information passed on through his sperm and could leave his children predisposed to obesity.

A man's weight affects the information passed on through his sperm and could leave his children predisposed to obesity.

 

The sperm cells of lean and obese men possess different epigenetic marks, maybe changing the behaviour of genes.

Dr Romain Barres, the author of the research, said: “When a woman is pregnant she should take care of herself. But if the implication of our study holds true, then recommendations should be directed towards men too.”

Part of the research – which was carried out by the University of Copenhagen and published in the journal Cell Metabolism – tested the sperm of six obese men who were undergoing weight-loss surgery.

It looked at the men’s sperm before treatment, a week after the surgery and then for a third time a year later.

Dr Barres said changes to the sperm were noticeable in the men a week after the surgery, and also one year on.

He said although the genetic make-up of the sperm cells was likely to remain the same, he noticed “epigenetic changes”, which could change the way a gene expresses itself in the body.

Dr Barres admits a definitive scientific conclusion for how these epigenetic changes affect the gene is not yet scientifically known.

However, the sperm cell changes he recorded are linked to the genes known for appetite control and brain development.

The five-year study also recorded similar sperm cell changes when it compared 13 lean men – who all had a BMI of below 30 – with 10 moderately obese men.

Dr Barres said his findings have also been corroborated on mice and rats.

He goes on to suggest that there are possible evolutionary reasons why information about a father’s weight would be valuable to offspring.

His theory is that during in times of abundance, it is an instinctive way to encourage children to eat more and grow bigger.

“It’s only recently that obesity is not an advantage,” he said. “Only decades ago, the ability to store energy was an advantage to resist infections and famines.”

Prof Allan Pacey from the University of Sheffield, described the study as “interesting” and said it provided further evidence to support the theory that some characteristics can be passed by sperm, without altering the basic structure of the genetic code.

“Whilst the study examines a relative small number of individuals, the fact that such significant differences can be found in the epigenetic markers of lean and obese men is intriguing and in my opinion worthy of more detailed investigation,” he said.

“Until we know more, would-be parents should just aim to be as healthy as possible at the time of conception and not be drawn to faddy diets or other activities in order to try and influence the health of their children in ways we don’t properly understand.”

 

Skipping breakfast increases your risk for diabetes and weight gain

We have all seen the commercials claiming it was the most important meal of the day.

We have all seen the commercials claiming it was the most important meal of the day.

Sure, my parents always told me breakfast was important but quite frankly, I didn’t care. I probably should have.

After nearly 10 years of skipping breakfast, I’ve finally changed my ways. Now, my morning meal ranges from donuts to green smoothies and full egg breakfasts. But no matter what it is that I’m eating, I do eat. Here’s why.

A couple of recent studies published by the American Journal of Clinical Nutrition show some of the shocking results of skipping breakfast.

In the first study, nearly 30,000 men were followed for 16 years to test the associations between skipping breakfast, eating frequency, snacking and the risk of Type 2 Diabetes.

Compared to men who ate three times a day, the men who skipped breakfast showed a 21 percent increase in the risk of Type 2 Diabetes regardless of their BMI or diet quality.

Eating breakfast could decrease snacking urges in adolescent girls

For adolescent girls, skipping breakfast is commonplace, but a new study shows that eating breakfast reduces snacking in overweight young women.

The researchers compared the effects of eating a 350-calorie cereal breakfast, a 350-calorie high protein breakfast (egg and beef), and skipping breakfast.

After taking blood samples, they found that eating breakfast of any type reduced the Skipping Breakfastamount of ghrelin (a hunger-stimulating hormone) and increased the daily peptide YY (appetite-reducing hormone) found in the blood stream.

Additionally, the high protein breakfast reduced high-fat food snacking in the evening, reduces cravings, improves satiety, and results in a better diet quality.

So yes, my parents were right, I shouldn’t have been skipping breakfast all those years. Plus, once I got in the habit of eating in the morning, the nauseous feeling went away, and, honestly, I don’t really know what I was thinking. Breakfast foods are the best!

 

 

 

Biological markers that can shed light on longevity

Active retirement- scientists have still not cracked the secret to living beyond 90

Active retirement- scientists have still not cracked the secret to living beyond 90

With the New Year, the search for a fountain of youth has existed almost as long as man.

The Greek historian Herodotus, who lived in the fifth century BC, wrote about the long-lived Macrobians who drank from a magical African spring. American schoolchildren learn that the Spanish explorer Ponce de Leon stumbled on to what is today’s Florida while looking for a youth restoring elixir.

Modern medicine has managed to extend life expectancy greatly, but that statistic has been achieved largely thanks to fewer deaths during childbirth, municipal sanitation, safe drinking water and the arrival of antibiotics. Science has not yet cracked the secret to living beyond 90, though researchers have identified areas — dubbed “blue zones” — where people do live longer than most.

Recent research has focused on telomeres — the tiny ends of chromosomes, which like shoelace tips keep the chromosomes from being degraded but eventually shorten and allow cells to age. But while small studies have shown that lifestyle changes can increase telomerase — an enzyme that repairs telomeres — there is no easy way yet to make use of this information.

One important insight that has emerged in recent research is that your chronological age — how old you are — can be dramatically different from what scientists call your biological age. A study recently released by Duke University in North Carolina found that in a group of one thousand 38-year-olds who had been followed for 12 years, their biological age varied from 26 to 61.

How can that be? Biological age is determined by combining important biomarkers of health such as blood sugar levels, cardiorespiratory fitness, and measurements of fat and cholesterol to produce a single number representation of age. If your blood sugar levels are higher than average, for example, your biological age could be higher than your chronological age. Alternatively, if you are extremely fit, your biological age could be much lower. Scientists have yet to agree which biomarkers to use.

A start-up company based in Boston called InsideTracker is trying to commercialise this insight in a fascinating way. For $99, the company sells a test called InnerAge, which analyses a drop of your blood and identifies five biomarkers: blood glucose, vitamin D, C-reactive protein (a measure of inflammation), liver function, testosterone for men and the hormone dehydroepiandrosterone sulfate for women. It then offers ways to improve these numbers. “The InnerAge number is just an estimate, but it gives you a red light saying you need to take care of yourself,” says Gil Blander, chief science officer at InsideTracker.

The company says it has combed scientific literature to find food combinations that can benefit health concerns. In my case, for example, I had higher than optimum blood glucose, so the firm recommended eating high fibre foods.

Dr Blander acknowledges that the tests leave out biomarkers such as cardiorespiratory fitness and body mass index, which have been found by other researchers to be key to longevity. But he says that the firm is hoping to include such measurements when reliable measuring devices can be found.

In other words, they are concerned people will tell porkie pies about their weight or exercise regimen, confounding the algorithm. Are people that vain?