A little-known side effect of widely-used OTC drugs

Society relies on over-the-counter (OTC) pain relievers to help ease the burden of everything from benign hangovers to common colds and even chronic pain. In fact, Americans’ consistent reliance on OTC pain relievers has spurred colossal growth in the industry, which was worth $19.3 billion in 2019 and is expected to grow by about 4% annually through 2028, according to forecasts from Future Market Insights.

Research suggests that 81% of adults use OTC medicines as a first response for many minor ailments. Easy access to these drugs without prescriptions provides symptomatic relief for an estimated 60 million Americans who would otherwise not seek treatment.

On the other hand, misuse of drugs like acetaminophen, ibuprofen, and aspirin lands nearly 200,000 people in hospital emergency rooms every year. These medications also carry the risk of considerable side effects like stomach bleeding, gastric ulcers, and liver damage.

But, another one of the risks (or is it a benefit?) of these ordinary medicines is little known and sparsely discussed, despite its huge implications: Mounting evidence suggests that in addition to reducing physical pain, OTC pain relievers can reduce social pain, too.

What is social pain?

Physical pain is just what it sounds like: an unpleasant sensation that can be felt in the body. Social pain is different. It is the experience of pain as a result of interpersonal rejection or loss, such as rejection from a social group, bullying, or the death of a loved one, according to the American Psychological Association.

Researchers suggest that these two types of pain involve similar neural mechanisms, and as such can be treated with similar medications. In 2010, psychology researchers used fMRI to measure brain activity and found that acetaminophen reduces behavioral and neural responses associated with the pain of social rejection, “demonstrating substantial overlap between social and physical pain.”

A separate study by other researchers found that women who took ibuprofen felt less social pain when they were excluded from a game or relived painful experiences, compared with women who took placebo. The situation was reversed for men. Men who took ibuprofen felt more hurt in social situations than those who took placebo. The authors still considered this finding significant because it “suggested that men responded in the opposite manner [to women] because the drugs disrupted their default tendency to suppress emotional pain.”

Are there downsides to blunting social pain?

Though reduced social pain might be a welcome result for many of those who take OTC pain relievers, it can also bring unwanted side effects, like reducing the ability to experience empathy.

In two randomized, double-blind, parallel-group, placebo-controlled trials, researchers led by Dominik Mischkowski, PhD, of the National Institutes of Health, found that after people read hypothetical scenarios that depicted other people’s physical or social pain, they reported feeling reduced perceived pain and personal distress themselves if they were taking acetaminophen. Another experiment within the studies found that people who took acetaminophen reported reduced perceived pain, personal distress, and empathic concern in response to an experimental incidence of social pain in which they were excluded from participation in a ball game.

“These reductions in empathic concern are particularly noteworthy because empathic concern is thought to be a key driver of prosocial behavior. It is thus conceivable that acetaminophen may also reduce willingness to help others in physical or emotional distress, though this prediction has to be tested in future studies,” Dr. Mischkowski and coauthors wrote.

What does this side effect mean for patients taking OTC pain relievers?

Despite the obvious benefits, blunting of social pain associated with OTC pain relievers is also concerning because it’s not widely known among consumers and hardly discussed in scientific circles.

“Consumers assume that when they take an OTC pain medication, it will relieve their physical symptoms, but they do not anticipate broader psychological effects,” wrote researchers at the University of California, Santa Barbara (UCSB). 

There’s reason to be excited, though. OTC pain relievers might help people deal with hurt feelings in the same way that they deal with minor aches and pains. “One could imagine taking acetaminophen after a flubbed work presentation or spousal disagreement,” the authors wrote. What’s more, further evidence could clarify whether OTC pain relievers might become part of treatment regimens for common mental illnesses like depression and anxiety.

However, the data suggest that the risks could outweigh the advantages. Empathy helps people build connections and support networks, which are important contributors to emotional well-being. Inability to feel empathy might compromise those networks. For people with depression, OTC pain relievers might dampen the ability to feel other emotions, like pleasure, which could worsen their condition.

At the other extreme, people who tend to suppress emotions might experience heightened emotional sensitivity on these drugs.

Because of these unknowns, the UCSB researchers recommended that further scientific studies weigh the risks and benefits of reduced social pain associated with OTC pain relievers.

“Found in medicine cabinets across the world and used multiple times per week by people of all ages, genders, and ethnic backgrounds, these drugs are woven into modern life,” they wrote. “Policymakers should take note of existing findings, but not rush to judgment.”