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?

 

One in five children are obese leaving primary school

One in 10 children was obese at the start primary school in England last year but one in five was obese by the end.

One in 10 children was obese at the start primary school in England last year but one in five was obese by the end

The reserach was carried out by to the Health and Social Care Information Centre.

Although figures for Reception children have fallen slightly, the figures for obesity in Year 6 are on the rise.

Children living in the most deprived areas were twice as likely to be obese as children in affluent areas.

Campaigners said the figures should act as a wake up call.

The figures for 2014-15 come from the government’s National Child Measurement Programme for England which covers all state primary schools.

By measuring children’s weight and height and calculating their BMI (body mass index) centile, they can be put into one of four categories: underweight, healthy weight, overweight or obese.

Among children aged four and five in Reception year, 9.1% were classified as obese – compared with 9.5% in 2013-14 and 9.9% in 2006-07, when records began.

In Year 6, 19.1% of children were obese – an increase on figures from eight years ago.

While one in four or five children was overweight or obese in Reception, one in three was either overweight or obese in Year 6.

The London boroughs of Southwark, Newham, Lambeth and Tower Hamlets topped the table for obesity among children aged 10 to 11 (Year 6).

The figures showed 28% of Year 6 pupils in Southwark were classed as obese and 44% were either obese or overweight.

Wolverhampton had the largest number of obese 10 and 11-year-olds outside London.

Waverley in Surrey reported the smallest number of obese pupils – 5% in Reception and 9% in Year 6.

Eustace De Sousa, national lead for children, young people and families at Public Health England, said tackling obesity was a major priority.

“While it is encouraging to see that overweight and obesity in children are levelling off, these figures are still unacceptably high and much worse in the poorest areas. The doubling of obesity levels between ages 4 and 11 is deeply concerning and highlights that much more needs to be done to help children and families.”

“We are committed to supporting local authorities by improving awareness locally, promoting the evidence behind ‘what works’ and providing advice to families through our Change4Life campaign.”

Fit legs equals fit brain, study suggests

Older women who have strong legs are likely to fare better when it comes to ageing of the brain, a decade-long study of more than 300 twins suggests.

Older women who have strong legs are likely to fare better when it comes to ageing of the brain, a decade-long study of more than 300 twins suggests.

The King’s College London team says leg power is a useful marker of whether someone is getting enough exercise to help keep their mind in good shape.

Exercise releases chemicals in the body that may boost elderly brains, say the scientists, in the journal Gerontology.

But they say more research is needed to prove their hunch.

It is difficult to untangle leg strength from other lifestyle factors that may have an impact on brain health and the study did not look specifically at dementia, experts say.

The researchers tracked the health of more than 150 pairs of twin sisters aged between 43 and 73 at the start of the study.

Leg power was measured (at the start of the study) using a modified piece of gym equipment that measured both speed and power of leg extension, while brain power was measured (at both the start and the end of the study) using computerised tasks that tested memory and mental processing skills.

Generally, the twin who had more leg power at the start of the study sustained their cognition better and had fewer brain changes associated with ageing measured after 10 years. And the finding remained when other known lifestyle and health risk factors for dementia were included.

Lead researcher Dr Claire Steves said: “When it came to cognitive ageing, leg strength was the strongest factor that had an impact in our study.

“Other factors such as heart health were also important, but the link with leg strength remained even after we accounted for these. We think leg strength is a marker of the kind of physical activity that is good for your brain.”

Alzheimer’s Society director of research Dr Doug Brown said the findings added to the growing evidence that physical activity could help look after the brain as well as the body.

“However, we still don’t fully understand how this relationship works and how we can maximise the benefit,” he said.

“And we have yet to see if the improvements in memory tests actually translate into a reduced risk of dementia.”

Alzheimer’s Research UK director of research Dr Simon Ridley said: “We know that keeping active generally can help reduce dementia risk, and it’s important to take into account strength training as well as aerobic exercise.”

Footballers have worryingly poor teeth

Professional footballers have worryingly poor teeth that could be affecting their performance on the pitch, say dentists.

Professional footballers have worryingly poor teeth that could be affecting their performance on the pitch, say dentists.

Their study on players at eight clubs in England and Wales, in the British Journal of Sports Medicine, showed nearly four out of 10 had cavities.

Regularly consuming sugary foods is one possible explanation.

The dentists, from the International Centre for Evidence-Based Oral Health at University College London, examined 187 players’ sets of teeth.

They found 53% had dental erosion, 45% were bothered by the state of their teeth and 7% said it affected their ability to train or play.

Around 40% had tooth decay, compared with 30% of people of a similar age in the general population.

Prof Ian Needleman, one of the researchers: “These are individuals who otherwise invest so much in themselves so it’s a surprising finding. There are two main groups – some have a catastrophic effect, they have very severe abscesses that stop them in their tracks and they cannot play or train.”

“There’ll be others experiencing pain affecting sleeping or sensitivity every time they take a drink. At this level of athlete, even small differences can be quite telling.”

Nutrition is one of the primary suspects with frequent consumption of sugary or acidic foods during training potentially accounting for tooth decay and erosion.

A lot of air in the mouth during exercise can also dry it out so there is less protection from saliva.

Prof Needleman said that while “these findings are worrying” clubs were giving dental health a “higher priority” and were educating their players.

Previous research has shown “striking” levels of bad teeth in athletes competing at the London 2012 Olympic Games.

The teeth of athletes at London 2012 were broadly in the same state as those of footballers.

Players from Manchester United, Hull, Southampton, Swansea, West Ham, Brighton, Cardiff and Sheffield United all took part in the study.

Stijn Vandenbroucke, the head of medicine and sports science at West Ham, said there were “clear preventive benefits for athletes and club”.

He added: “Oral health is an area where many athletes have greater problems than the general population so it has been a massive achievement for so many professional football clubs to collaborate with each other to help us understand the scale of this problem better.”

5 Simple Tips for Getting in Shape

Getting in shape shouldn’t be a chore.

Getting in shape shouldn't be a chore.

In fact, there are many easy ways to incorporate exercise into your everyday activities or focus on things you already love to do.
If you’re busy, don’t let it stop you. Try and fit more activity into the things you already do every day – whether at home or at work:

1. Just Move More

Choose the stairs. Youíll get a workout and avoid the awkward elevator rides. For a more strenuous workout, go up and down the stairs for 15 minutes.
Park farther away. Running errands, at work or dropping off kids, park as far away as you can to add a few more steps into your day.
Take walking breaks. Leave your desk occasionally to take a break to walk outside when the weatherís nice or stay inside and explore different areas of the building. This will give you a little stress break and let your eyes rest after staring at a computer screen. Also, it will add in a few more steps and youíll feel more rejuvenated when you get back to your desk.

2. Do What You Love

Maybe you enjoy rollerblading, perfecting your garden or snow skiing with your kids. When you enjoy exercise, youíre more likely to keep it up. You might want to try:

Walking with friends
Trying a new yoga class
Picking up snowshoeing or cross-country skiing
Joining a local recreation basketball or racquetball league
Going swimming at a nearby pool
Shooting hoops
Participating in a dance class
Biking around a local park with your kids

3. Set Small, Realistic and Specific Goals

If you decide to pick up jogging, start with running for 30 seconds and walking for two and a half minutes. The next week, run for 45 seconds and walk for one minute. Before you know it, you will be running for two-three minutes before you need to take a short walking break.

And if you have some setbacks, thatís OK. In the end, youíll see success if you stay consistent.

 

4. Plan for the Long Haul

Doctors recommend exercising for 30 minutes at least five times a week at a moderate level of activity (like gardening or walking). If that sounds overwhelming, build on small goals month-by-month.

5. Recruit Help from Friends

What else is going to help you reach your goals? Stay patient and positive until you get there ñ and you will get there.

Life changes are much easier to manage with a group of close friends and family supporting you. If you know someone whoís already active, ask them for tips or be brave and join them! In the end, it doesnít really matter how you exercise, whatës most important is finding a way to exercise doing what you love and making it a part of your daily routine.

Why short bursts of activity boost fitness in the body

High-intensity training (HIIT) has become popular with athletes and amateurs and now scientists know why.

High-intensity training (HIIT) has become popular with athletes and amateurs and now scientists know why

Short bouts of intense exercise could be the key to staying in shape after researchers found that even just a few minutes of strenuous activity can make muscles work harder.

High-intensity interval training (HIIT) has become popular with athletes and amateurs and has clear visible benefits.

But sports scientists have always struggled to understand how a short amount of activity can produce similar effects as endurance training.

Now, researchers at the Karonlinska Institute in Sweden have found that even small levels of intensive exercise boost the production of mitochondriañ the cellís batteries ñ which enhance muscle endurance.

Volunteers who cycled for 30 seconds as fast as possible, six times, triggered the effect, suggesting just a few minutes is all it takes for results to begin to show. Tissue samples of their muscles showed benefits.

ìOur study shows that three minutes of high-intensity exercise breaks down calcium channels in the muscle cells,î says Professor Hakan Westerblad, principal investigator at Karolinska Institutetís Department of Physiology and Pharmacology.

ìThis causes a lasting change in how the cells handle calcium, and is an excellent signal for adaptation, such as the formation of new mitochondria.î

Can 20 seconds of high intensity exercise really beat a session in the gym?

Mitochondria are like the cellís power plants, and changes that stimulate the formation of new mitochondria increase muscle endurance.

However the researchers also found that anti-oxidants like vitamin E and C can stop the effect.

ìOur study shows that antioxidants remove the effect on the calcium channels, which might explain why they can weaken muscular response to training,î added Professor Westerblad.

The study was published in the journal PNAS.