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PaperclipPerfector  25d ago (text post)   2849 thread views

Small-Scale Question Sunday for October 27, 2024

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Inspired by another poster who wrote about misadventures with Tylenol, I just want to provide a brief commentary on medications.

More medication is not necessarily more better.

Many medications essentially work by targeting a receptor of interest or receptors of interest.

If you double the dose you might go from 95% of the effect you want to 98% of the effect you want, while also saturating other receptors that cause side effects.

For ones that are more receptor specific (like Ibuprofen (Advil)) we find that things like doubling the dose from 400 to 800 has little impact on pain, more of an impact on anti-inflammatory properties, and a massively increased risk of side effects.

Don't just take a handful of pills expecting more to do more of what you want!

Here's everyone's daily reminder that the standard melatonin dose sold (10mg) is literally 100x too strong. 0.1mg is much more effective.

Welllllll no.

I know Scott's article makes a case but it's way more complicated than that.

Sleep medicine, Psychiatry, and PCPs all have wildly different views about Melatonin all of which can be simplified as "sure, fine, it's safe" but a lot is happening under the hood there.

Some evidence it does absolutely nothing.

Research is complicated because anxious college students, the elderly, someone in a Psychiatric inpatient unit recovering from an episode of something, and a 40 year old man with a bowel perf in the hospital all have wildly different sleep needs and problems. Makes research very hard.

Then you add in the stuff like spaced dosing being more effective...

I’m pretty can still feel pain if I pinch myself while on Ibuprofen. Different receptors? I assumed it was low-strength but didn’t think too hard about what that meant.

The physiology of pain is very complicated. Briefly - Ibuprofen is an NSAID, a non-steroidal anti-inflammatory drug it basically works by turning off a part of the inflammatory response which is a large part of most types of pain. Bowel pain? Inflammation. Healing wound? Inflammation. Stub your toe? Inflammation.

If you have the right type of pain it can be immensely effective, even more effective than opioids in the sense that it can actually "heal" the pain instead of just doing other stuff (if swelling is pushing on a nerve for instance).

However it can be bad for you because you need inflammation......

For the wrong type of pain it's not going to do a lot.

A good rule of thumb is that if swelling is involved you'll want to use ibuprofen, if it's not Tylenol.

However how functional your liver kidneys, and gastric system etc. are matters a lot.

The specific example is interesting. I don't notice a damn thing from NSAIDs for pain that can reasonably be assumed to be inflammatory, and IIRC they're indistinguishable from placebo for osteoarthritis pain.

I found NSAIDs to do literally nothing for me for like 30 years across all sorts of injuries, then I encountered a very specific sort of neck-back ache resulting from poor form on power cleans that two ibuprofen instantly fixed. I could literally feel when the last dose would metabolize because the pain was so intense when present. I was basically chowing down on 8 pills a day for the week of that, otherwise I was unable to sleep or move my neck. Pain is weird.

Like I said pain is complicated, likewise pharm is complicated - some people are fast metabolizers of certain medication and get no effect at all.

Personally I find NSAIDs to be even better for low dose opiates for pain associated with significant inflammation (for me).

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