681: Avoidant Attachment Moderates the Analgesic Effect of Acetaminophen (Paracetamol)

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Psychology, Pharmacological treatments, Assessment and Measurement of Pain/Nociception

Background and Aims: Effective pharmacological pain management remains important to lessen the individual or societal impacts of pain. Despite wide-spread use, however, pharmacological treatments of pain, especially for chronic pain, are only moderately effective at best. To explain variability in painkiller effectiveness, we tested a psychosocial moderation hypothesis of pharmacological analgesia (Gharavi & Mischkowski, 2025) which suggests that dispositional psychosocial factors modulate painkiller effectiveness. Interpersonal attachment style constitutes such an important psychosocial factor – not only regulating pain but likely also pain management (Meredith et al., 2008). We therefore tested whether attachment style modulates the analgesic effects of acetaminophen (paracetamol), a popular over-the-counter painkiller.

Methods: Using double-blind drug administration procedures, 178 healthy undergraduate volunteers (125 females; MeanAge = 19.28, SD = 1.41; 99 Whites, 44 Asians/Asian Americans, 16 Black/African Americans, 19 mixed race/others) were randomly assigned to consume either 1000 mg liquid acetaminophen (n = 89) or an identically tasting placebo (n = 89). Next, participants complete the 36 items of the Experiences in Close Relationships – Revised scale (Fraley et al., 2000), a two-dimensional measure of anxious and avoidant attachment. About 60 mins after drug consumption, participants provided measures of heat pain threshold and tolerance, using the Methods of Limits (Gescheider, 1997).

Results: Avoidant attachment moderated effects of acetaminophen on heat pain threshold (ΔR² = .031, F(1, 174) = 5.66, p = .018). At high levels of avoidant attachment (1.51 SD above the mean), acetaminophen relative to placebo increased pain threshold (b = 1.73, SE = 0.87, p = .050), suggesting analgesic effects. At low levels of avoidant attachment (1.36 SD below the mean), acetaminophen relative to placebo decreased pain threshold (b = -1.54, SE = 0.78, p = .050), suggesting hyperalgesia. Avoidant attachment did not moderate acetaminophen’s effects on pain tolerance levels, nor did anxious attachment moderate any effects of acetaminophen on either pain threshold or tolerance (all ps > 0.05).

Conclusions: Acetaminophen’s analgesic effects depended on the avoidant attachment style of consumers. Specifically, acetaminophen showed analgesic effects for people high in avoidant attachment. In contrast, acetaminophen increased acute pain sensitivity in people low in avoidant attachment. These findings provide initial support for our psychosocial moderation hypothesis of pharmacological analgesia (Gharavi & Mischkowski, 2025), showing that psychosocial factors can explain inter-individual variability in painkiller effectiveness. More research is needed to identify other psychosocial factors influencing the effectiveness of pharmacological analgesics, such as acetaminophen. Such research has the potential to inform more targeted pharmacological care for people suffering from acute or chronic pain.

References: Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology., 78(2), 350–365. https://doi.org/10.1037/0022-3514.78.2.350
Gescheider, G. A. (1997). The classical psychophysical methods. In G. A. Gescheider (Ed.), Psychophysics: The Fundamentals (3rd ed., pp. 45–72). Mahwaw, NJ.
Gharavi, E., & Mischkowski, D. (2025). On the role of psychological and social factors in pharmacological analgesia: A psychosocial moderation hypothesis. Psychological Review. https://doi.org/10.1037/rev0000536
Meredith, P., Ownsworth, T., & Strong, J. (2008). A review of the evidence linking adult attachment theory and chronic pain: Presenting a conceptual model. Clinical Psychology Review, 28(3), 407–429. https://doi.org/10.1016/j.cpr.2007.07.009

Presenting Author: Dominik Mischkowski
Submitting Author: Dominik Mischkowski

Senior Author: Dominik Mischkowski

IASP 2026 Global Year theme of Neuropathic Pain: No

• Ehda Gharavi - University of Illinois at Urbana-Champaign