The interrelationship between chronic pain and AUD resides in the intersection of etiological influences, mental experiences, and neurobiological processes. Not only does early and protracted abstinence induce a type of pain characteristic of early recovery, but it also has the tendency to exacerbate dysregulated nociception (Egli et al., 2012). In cases where pain among AUD individuals results from a comorbid condition (e.g., cancer, neuralgia, fibromyalgia), abstinence of any duration can reveal the presence and intensity of pain that was previously being masked by the analgesic effects of alcohol.
If you find that you’re relying on alcohol to get through the day or to manage your pain, know that you’re not alone, and that there is help available. Together, we can explore safer pain management strategies and, if needed, connect you with resources for substance use support. Sleep is a critical part of managing chronic pain, but while alcohol might help you fall asleep faster, it interferes with the deeper, restorative stages of sleep that we need so our bodies can heal.
Research has shown that chronic alcohol use can cause long-term, painful nerve damage, known as alcoholic neuropathy. If you use alcohol to relieve your pain, it is important to learn about possible adverse health effects. While the idea of abstaining completely may feel daunting, there’s a growing cultural shift toward mindful drinking, or not drinking. Younger generations are drinking less and non-alcoholic beverages are becoming more popular. Dietary Guidelines for Americans continued to recommend that men consume no more than two drinks per day and women no more than one.
AUD may share common neural pathways with chronic pain, which may facilitate pain affecting alcohol use patterns, or facilitate modulatory effects of alcohol on pain processing, thereby precipitating the risk of chronic pain development. It is influenced by a host of familial, biological, environmental, and socioeconomic mediators that affect drinking behavior and susceptibility to pain disorders. The onset of chronic pain may precede memory problems, and chronic pain has been shown to increase the risk of dementia in older adults (Whitlock et al., 2017). Compared to healthy controls, individuals suffering from chronic back pain or complex regional pain syndrome have a smaller hippocampus, a brain structure that is involved in memory formation and consolidation (Mutso et al., 2012). In a mouse model of chronic pain, it was shown that production of new neurons in the hippocampus failed. This finding was surprising given that the hippocampus is a brain region in which new neurons can grow both in adult humans and in adult mice (Mutso et al., 2012).
Alcohol and Pain Management: A Bidirectional Relationship
- 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).
- Get out and take an easy walk, do some gentle stretches or movements while focusing on your breath.
- This indicates that the inflammatory pathways involved are different and could potentially lead to the development of targeted therapies in the future.
- Additionally, people with alcohol use disorder experience allodynia during alcohol withdrawal.
- This finding was surprising given that the hippocampus is a brain region in which new neurons can grow both in adult humans and in adult mice (Mutso et al., 2012).
- We then proceed by proposing some potential mechanisms involved in the development of chronic pain in AUD.
However, those guidelines also emphasize that people who don’t currently drink shouldn’t start. “A lot of people with this genetic variant are aware of some of the visible symptoms, but they don’t know that it means alcohol really puts them at more risk than other people,” Chen said. Newer studies are also uncovering how alcohol may interfere with the immune system and accelerate molecular signs of aging.
Analgesic doses of alcohol exceed levels recommended in the Dietary Guidelines for Americans, 2020-2025
Furthermore, these findings suggest that the level of alcohol consumption needed to provide sustained moderate-to-large analgesia for persistent pain exceeds most countries’ guidelines for safe drinking. As such, efforts to promote awareness of alternative pain management strategies (e.g. physical therapy, exercise, controlled use of pain medication) with fewer long-term health consequences to vulnerable people is likely to be beneficial. Chronic pain syndromes have the propensity to trigger the risk of initiating alcohol abuse, or triggering relapse in individuals who had attained abstinence. Characterization of the interrelatedness of alcoholism and pain allows for early detection and treatment of patients at risk for developing chronic pain conditions, and for preemptive interventional approaches to reduce the risk of consequent alcohol abuse. Because pain has a negative impact on alcohol overconsumption among individuals in treatment for AUD, researchers have investigated whether addressing pain within the context of treatment for alcohol or substance use disorders may be beneficial for drinking outcomes. Among patients receiving pain management cognitive behavioral therapy (CBT), lower pain ratings (Morley et al., 1999) and greater self-efficacy in managing pain, were seen among individuals in treatment for substance use disorders (Ilgen et al., 2011).
- Laboratory studies confirm that alcohol does indeed reduce pain in humans and in animals.
- Alcohol use disorder (AUD), which encompasses the conditions commonly called alcohol abuse, alcohol dependence and alcohol addiction, affects 29.5 million people in the U.S. according to the 2021 National Survey on Drug Use and Health.
- In the alcohol-dependent mice, allodynia (in which a harmless stimulus is perceived as painful) developed during alcohol withdrawal, and subsequent alcohol intake significantly decreased pain sensitivity.
- We can break free from this cycle and work towards a pain-free life by quitting or cutting back on alcohol.
- A dose-response relationship was also observed, with increasing levels of alcohol resulting in increasing analgesia (with alcohol dosages ranging from the equivalent of around half a pint of lager to three pints).
Being honest about how much you’re drinking allows us to fully understand your health picture and give you the best care possible. It also opens the door to more support, whether that means adjusting medications, connecting you with resources, or just having a conversation about what you’re going through. Alcohol can temporarily reduce our perception of pain by slowing down messaging in our brain, but it doesn’t actually make the pain go away. Let’s say we’re sick and tired of the constant pain, and we decide to have a drink to take the edge off.
When we drink, our brain releases serotonin and dopamine (our brain’s “feel good” hormones), which help us relax in the moment and feel a sense of pleasure. Alcohol can also help us relax physiologically by slowing down our heartbeat and releasing tension in our muscles (again, temporarily). These things alone can take over our brain’s reward system and drive us to come back for more.
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Yes, alcohol can cause nerve damage and lead to chronic inflammation, increasing the risk of chronic pain. Alcohol might seem like a quick fix, but its role in the cycle of pain is far from simple. Let’s delve into how alcohol affects chronic pain, and what that means for those of us who are seeking real, lasting relief.
Dysregulation of the Mesocorticolimbic Reward Network.
Family history of AUD also could be a mediating risk factor for comorbid affective disorders in pain patients. In a study on the relationship between fibromyalgia and familial history of depression and AUD in first-degree relatives (Katz & Kravitz, 1996), patients who had both fibromyalgia and depression also had higher odds of AUD in their first-degree relatives. Another family history study on prepubertal children suggested that the risk of prepubertal onset of major depressive disorder in families with a high aggregation of affective disorders is higher when there also is a high prevalence of AUD in the families (Puig-Antich et al., 1989). Overall, these results suggest that alcohol does deliver effective relief from pain – at least for the type of relatively short-term pain induced in the laboratory. While there is uncertainty regarding the precise mechanism(s) underpinning the pain relieving effects of alcohol, suggested Alcohol and Pain mechanisms include both indirect (e.g. through the reduction of anxiety) and direct effects (e.g. via the blocking of NMDA receptors in the central nervous system). Additionally, people with alcohol use disorder experience allodynia during alcohol withdrawal.
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As mainly central rather than peripheral mechanisms are thought to be involved in the chronification of pain, identifying structural and functional differences in the brain in relation to AUD is key to recognizing links between the two conditions. Herein, we begin with a review of the neural bases of pain, and we discuss the influence of alcohol on processes involved in pain perception. We then proceed by proposing some potential mechanisms involved in the development of chronic pain in AUD. Finally, management of chronic pain in AUD patients cannot be optimized without considering the reciprocal risks and benefits of the treatment choices on exacerbating drinking patterns or increasing the risk of relapse.
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This dynamic can present unique challenges for recovering individuals suffering from acute and/or chronic pain, as well as for the physicians responsible for treating both conditions. In the alcohol-dependent mice, allodynia (in which a harmless stimulus is perceived as painful) developed during alcohol withdrawal, and subsequent alcohol intake significantly decreased pain sensitivity. 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. Over time, using alcohol to manage pain can lead to more health problems, including increased sensitivity to pain, trouble sleeping, and a higher risk of dependence. While an occasional drink might not be harmful for some, using alcohol regularly or heavily to manage pain is not a healthy long-term solution. The investigators found that, of the problem drinkers, approximately 43% of men and 44% of women reported experiencing moderate to severe pain, but in nonproblem drinkers, only 28% of men and 33% of women reported that level of pain.
AUD involves preoccupation or craving, intoxication, withdrawal, and negative affect. Neural substrates of AUD involve widespread mesocorticolimbic and cerebro-cerebellar networks. Both conditions involve dysfunction of extended reward and oversight circuitry, and particularly prefrontal cortex.