Opioids in particular may not be appropriate for managing pain in individuals with AUD, as they probably engage the same brain reward pathways as in AUD. Indeed, there is evidence for the involvement of the endogenous cannabinoid system in the pharmacological and behavioral effects of alcohol (Perra et al., 2005). However, gabapentin, a GABA analogue anticonvulsant medication that also is used to treat pain, has been shown to have the benefit of reducing cravings and to significantly delay relapse in individuals with AUD (Brower et al., 2008). When levels of inflammatory proteins were measured, the researchers discovered that while inflammation pathways were elevated in both dependent and non-dependent mice, specific molecules were only increased in dependent mice. It also indicates which inflammatory proteins may be useful as potential targets for intervention to combat alcohol-related pain. Follow-up studies are focused on how these molecules might be used to diagnose and more effectively treat alcohol-related chronic pain conditions.
- Also, poor sleep can intensify pain, reduce your ability to cope with discomfort, and worsen fatigue and mood issues.
- Separately, about half of the mice that were not dependent on alcohol also showed signs of increased pain sensitivity during withdrawal, but unlike the dependent mice, this pain was not reversed by re-exposure to alcohol.
- They are also more likely to already be living with chronic diseases, and to be taking prescription medications that might interact poorly with alcohol.
- Attention, expectation, and reappraisal are thought to be the most important contributing factors for the cognitive modulation of pain (Porro et al., 2002; Wiech, Ploner, & Tracey, 2008).
- Alcohol can interact negatively with many pain medications, including opioids, muscle relaxants, antidepressants, and anti-inflammatories.
A systematic search found 18 eligible experimental studies, involving a combined total of 404 healthy participants. All those taking part were exposed to painful experimental stimulation after being allocated to an alcohol or a no-alcohol control condition. Pain was assessed in a variety of ways, including pain ratings (0-10) and pain threshold (the point at which pain is first experienced). Studies were generally of good methodological quality; many reported randomisation of participants to conditions, precise measurements of blood alcohol and use of placebo groups who were given negligible levels of alcohol to reproduce its taste and smell.
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Conventional medical or alternative treatments for chronic pain are safer, more sustainable options than alcohol use for chronic pain management. Alcohol is a central nervous system depressant that can temporarily numb pain sensations and induce feelings of relaxation. Initially, this may seem beneficial for pain management; however, research shows that chronic use of alcohol worsens chronic pain. As pain specialists, we understand that people often turn to alcohol because they’re struggling. Whether it’s physical pain, emotional stress, or sleep issues, you’re doing your best to cope.
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Of those, the majority (79%) of the individuals identified self-medication for pain as the reason for heavy alcohol use. The analgesic effects of alcohol on pain perception have been measured in a variety of ways, including examining pain threshold, tolerance, and pain ratings (e.g., intensity). Regarding ratings of discomfort versus intensity of pain, alcohol alleviates discomfort at lower doses and to a greater extent than intensity, suggesting the effect of alcohol may vary across components of pain. In addition, pain is influenced by alcohol dose and blood alcohol concentration (BAC), with the magnitude of the analgesic effects increasing at higher BACs (Cutter et al., 1976; Gustafson & Kallmen, 1988; Horn-Hofmann et al., 2015; Stewart, Finn, & Pihl, 1995; Thompson, Oram, Correll, Tsermentseli, & Stubbs, 2017). Studies also have shown that alcohol has less of an impact on pain as the BAC drops, due to metabolism, excretion, or evaporation (Duarte, McNeill, Drummond, & Tiplady, 2008; Horn-Hofmann et al., 2015; Zacny, Camarillo, Sadeghi, & Black, 1998).
- They found that 87% of those who screened positive suffered from chronic pain as well.
- Dietary Guidelines for Americans continued to recommend that men consume no more than two drinks per day and women no more than one.
- Now that we understand the major role that alcohol can play in chronic pain, we can implement healthier, more sustainable ways to manage it.
- These approaches transform our relationship with our thoughts, emotions, and physical sensations, including pain.
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If you’re taking medications to manage your pain, talk to your doctor or pharmacist about any reactions that may result from mixing them with alcohol. Some legislators have even proposed adding warning labels on alcohol products — similar to those on nicotine products. Chen likes the idea, given that fewer than half of all American are aware of the link between alcohol and cancer.
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In people with nerve pain, even moderate alcohol use can damage the nerves further and intensify symptoms. And for those dealing with back or spine issues, alcohol-related inflammation or muscle relaxation can sometimes increase the risk of injury or instability. Pain perception is a subjective, complex, and distributed process that involves multiple structures involved in sensory, emotional, and cognitive processing that interact together concurrently to form the perceived pain experience (Chapman, 2005).
While ALDH2 is the most common inherited variation to affect how well someone can handle alcohol — and its’ long-term risks — it is not the only factor. Some people are already at higher risk of chronic diseases like diabetes and heart disease because of their genetics or other risky behaviors like tobacco use. Even over-the-counter medications like acetaminophen (Tylenol) can be harmful when mixed with alcohol, putting strain on the liver and increasing the risk of long-term liver disease. If you’re undergoing treatment or taking any medications for pain, it’s important to talk to your doctor about alcohol use. Alcohol Use Disorder (AUD) and chronic pain are widespread conditions with extensive public health burden. This review seeks to describe neuroanatomical links and major mediating influences between AUD and chronic pain, in the service of identifying factors that predict the risk of chronic pain in precipitating or facilitating AUD.
Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) are evidence-based approaches that incorporate mindfulness practices. ACT emphasizes building psychological flexibility and emphasizes values-congruent practices, while DBT emphasizes the development of emotional regulation and distress tolerance skills. These approaches transform our relationship with our thoughts, emotions, and physical sensations, including pain. This can change the quality of our experience in ways that change the subjective experience of pain as well as the suffering precipitated by it. It’s not unusual for people with chronic pain to consume alcohol to self-medicate—to drink to help sand down the sharp edges of their pain and turn down the volume of their discomfort. However, what starts out as something that seems like a solution often becomes part of the problem and can even make chronic pain worse.
Let’s work together to find safer, more effective strategies that truly improve your quality of life. It is estimated that 50% to 60% of the total variance in risk for AUD is accounted for by variation in genetic factors (Rietschel & Treutlein, 2013). Twin studies and studies of the offspring of individuals with AUD have shown that family history of AUD mediates the risk of AUD. Children of patients with AUD are at as much as four times higher risk of developing AUD. But controversy exists regarding whether family history is a risk factor through genetic mechanisms, or through environmental mechanisms (e.g., growing up in a household with parents with AUD), or through the interaction of genes and environment. Irrespective of the mechanism involved, family history of AUD is a profound risk for AUD.
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Because physical and emotional pain are related and activate one another, addressing depression, sadness, frustration, irritability, anger, anxiety, and fear has multi-level benefits. By shifting perspective and adjusting one’s thinking, it’s possible to change emotional responses and, in turn, dramatically decrease the level of suffering. Moderate drinking is typically defined by public health agencies as up to one alcoholic drink per day for women and up to two for men. A standard drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.
Impaired cognition can modulate the cognitive-evaluative dimension of pain experiences, both as a reinforcing factor for alcohol-seeking behavior (as alcohol is known to alleviate pain) and also in how pain is perceived. Additionally, physiological cues accompanying alcohol consumption can influence drinkers through modulating their expectancy. It should be noted that this model does not rule out or ignore the role of biological factors in the development of chronic pain, but instead emphasizes the significance of reinforcement and learning in the development and maintenance of chronic pain (Gatzounis, Schrooten, Crombez, & Vlaeyen, 2012). For instance, it is likely that dopamine release in the mesocorticolimbic dopamine system (precipitated by consuming alcohol) is responsible for relief from acute pain. In turn, relief from acute pain can be a positive reinforcing factor for maintenance of the pain state as it will lead to reward (alcohol intake and resulting dopamine release), with the alcohol itself acting then as a negative reinforcing factor. Approximately 15 million Americans suffer from alcohol abuse or dependence (National Survey on Drug Use and Health 2015 (“National survey on drug use and health – SAMHSA,” 2015), and an estimated 116 million American adults suffer from chronic pain (Egli, Koob, & Edwards, 2012; Grant et al., 2004).
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For pain ratings, pain was rated at around 5/10 in the control condition, which was reduced by around 25% after administration of alcohol. A dose-response relationship was also observed, with increasing levels of alcohol resulting in increasing Alcohol and Pain analgesia (with alcohol dosages ranging from the equivalent of around half a pint of lager to three pints). They also found increased levels of IL-6 and activation of ERK44/42 in mice with alcohol withdrawal-related allodynia, but not in mice with alcohol-induced neuropathic pain. When Roberto’s group then measured levels of inflammatory proteins in the animals, they discovered that while inflammation pathways were elevated in both dependent and non-dependent animals, specific molecules were only increased in dependent mice. It also suggests which inflammatory proteins may be useful as drug targets to combat alcohol-related pain. Given the general level of interest in this area, there were fewer studies than we expected.
The researchers found that there was a significant increase in drinking behavior in the group of mice that were dependent on alcohol compared to the non-dependent group. The potential of alcohol to act as a painkiller has been recognized for a long time, and many drinkers report that they consume alcohol to moderate pain. The initial contact points — mouth, throat, esophagus and stomach — are most vulnerable, which is why these areas show some of the strongest links to alcohol-related cancers. But acetaldehyde and alcohol’s other metabolic effects also impact the liver, where it contributes to inflammation and fatty liver disease, and the brain, where it disrupts signaling related to mood, memory and decision making. The studies, however, had some major flaws, including that people’s drinking was generally categorized only by their current behavior.
A 2024 report from the American Association for Cancer Research concluded that more than 5% of all cancers in the U.S. are attributable to alcohol use. The more alcohol consumed, the greater the risk of cancer, but the risks start with any alcohol consumption. “In the past 10 years or so, in my practice, I’ve added alcohol to the list of substances I recommend my patients either reduce or eliminate from their diet,” said Randall Stafford, MD, PhD, a professor of medicine and director of the Program on Prevention Outcomes and Practices.
He has previously worked as a consultant statistician in the area of patient-reported outcomes in the US. He enjoys research examining the neurophysiological foundations of pain and exploring the potential for technology in pain management. In the meantime, while chronic pain should always be evaluated by a medical professional, there are many options for medication/opioid-based treatment, drawing on complementary and alternative approaches.
