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Who Answers?Alcohol and chronic pain can be related in several ways. For those who have suffered from chronic pain, you know firsthand how the pain demands your attention. It impacts your relationships, your ability to participate in activities you love, your capabilities at work or school, and it reduces your quality of life.
It’s the human condition to attempt to free ourselves from suffering in the best ways we know how.1 Unfortunately, because of this, you may have misused alcohol as a means to reduce the suffering experienced with chronic pain.
What Is Chronic Pain?
Pain is an experience we all have as humans. Acute pain is healthy. It indicates that something is wrong and that we need to tend to it. Once we recover, healthy pain will subside as it no longer requires our attention for protective action. This type of healthy pain often gets described as a fire alarm that is operating correctly.5
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience,” with chronic pain defined as, “an unpleasant sensation associated with actual or potential tissue damage.”4
With chronic pain, the body’s fire alarm will not turn off, even after you’ve tended to the fire and put it out.5
There is a mystery in chronic pain. After healing has occurred, the pain persists and no longer indicates actual tissue damage. However, the brain perceives that continued protective awareness is needed. Therefore, in chronic pain, the experience of pain is more about sensitivity to a potential threat than it is about actual damage itself.6 This distinction can be challenging for the person experiencing the pain because the pain is persistent, debilitating, and the desire for relief is paramount.
What Causes Chronic Pain?
Acute pain has a clear, observable cause and effect: there is an injury, pain occurs, and the pain is relieved when the injury heals. Chronic pain, however, can occur with or without an identifiable injury. Chronic pain can persist despite treatment. It can occur at both predictable and unpredictable times and was associated with several physical and psychological diagnoses.6
Chronic pain has been the subject of many medical studies, but no definitive conclusions can be drawn than indicate a single cause for why it occurs. 4 Over time, the medical community has identified several physical conditions associated with chronic pain.
Permanent or Untreated Injury
When you have experienced an injury, you may have nerve damage, scar tissue, or compensatory reactions that lead to chronic pain.5 For example, muscle groups on one side of the body can become strained to compensate for weakness due to nerve damage on the other side. Nerve damage can even be caused by a condition or by excessive alcohol use, as in the case of alcoholic polyneuropathy.
Surgery
Surgery can lead to chronic pain due to how scar tissue may develop. Scar tissue can potentially obstruct natural movement patterns.5
Underlying Disease
Progressive musculoskeletal conditions such as fibromyalgia, rheumatoid arthritis, and osteoarthritis are recurrent and lead to chronic pain. Autoimmune conditions and related disease like multiple sclerosis, ulcerative colitis, cancers, and AIDS are also associated with the development of chronic pain. 4, 5
There is a high occurrence of chronic pain among individuals with a body mass index (BMI) which places them in the “obese” category. This rate of occurrence is thought to result from several factors, including barriers to receiving treatment such as physical therapy and surgery and a cyclical relationship between higher weight and mobility issues directly linked to pain.
Anticipating Pain Can Lead to Pain
When you have a recurrent condition such as fibromyalgia or an autoimmune condition characterized by flare-ups, the dread associated with experiencing pain can cause a negative feedback loop within the nervous system. This negative feedback loop is one of the causes of chronic pain.7
How Is Chronic Pain Linked to Trauma?
Trauma is considered one of the primary risk factors for developing substance misuse or addiction. Trauma history is also linked to chronic pain.
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Help is standing by 24 hours a day, 7 days a week.Who Answers?Chronic pain operates in your brain much like psychological trauma operates in your mind. In chronic pain, your body was harmed initially or experienced the threat of harm. The initial acute pain was beneficial to motivate you to tend to the damage of your body.6 However, in chronic pain, the brain did not receive the message that the threat has passed. In an effort to continue to protect you, your brain does not allow the alarm function of otherwise healthy pain to turn off.5
Biological trauma response is similar. Most traumatic experiences trigger the fight, flight, or freeze response, as well as intense feelings such as fear. After the trauma, the chemicals that cause these responses dissipate and do not come back as intensely when you remember the incident over time. However, some trauma continues to make your body to react as if there was a current threat even when you are safe. This is the case in post-traumatic stress disorder (PTSD). 8 One symptom of PTSD is hyper-alertness—also called hypervigilance—a readiness to mobilize into action to stop a threat, even if that danger is not present in that moment. 9 Hypervigilance can cause anxiety and make you startle more easily.
In PTSD, you may experience flashbacks of the trauma. These flashbacks are so real that you may dissociate and reenact the trauma, experiencing the same fight, flight, and freeze physiology that occurred during the actual traumatic event.8 While some people see or remember visual cues from the traumatic experience, you may have other sensations like smelling or feeling something that is not there in reality.
Flashbacks can include feeling pain sensations that are virtually identical to the pain of an acute injury that occurred during a traumatic event. This perceived pain may create or worsen chronic pain symptoms related to permanent injury or scar tissue.
Research demonstrates a significant correlation between those who have experienced trauma and reports of chronic pain.10 Those who have experienced childhood abuse report more incidents of chronic pain than those who did not experience childhood abuse. Additionally, those who have experienced abuse in childhood and intimate partner violence in adulthood have the highest reports of chronic pain. These findings appear to show an association between the frequency of trauma and the experience of pain.10
How Is Chronic Pain Linked to Addiction?
Both trauma and chronic pain are factors that can increase the likelihood that a person will develop a substance use disorder—the clinical diagnosis for the set of behaviors commonly understood as “addiction.”6 A substance use disorder is a biological and psychological dependence on a substance to provide temporary pleasure or relief.11
Substance use often starts as a means to cope with symptoms, like pain or distress due to hypervigilance, in a way that is within your control. If you are in physical or psychological pain to the point that you cannot sleep, you may use a sleep aid. However, substance misuse often begins to occur when you have few or no other means of addressing the pain. This progression from substance misuse to a physical and psychological dependence on a substance to function mentally, physically, or emotionally which may then become addiction is why substance use disorder is often a secondary diagnosis.12
While alcohol use can temporarily relieve some pain and trauma symptoms, however, misuse has been linked to an increase in overall pain.2 Depending on the severity and duration of overuse, alcohol can lead to the development of additional types pain due to its physical effects.3
What Are the Risks of Alcoholism and Chronic Pain?
As understandable as it is to desire to escape the debilitating discomfort of chronic pain via alcohol, there are dangerous risk factors associated with misuse. One of the most significant risk factors is accidental overdose when you mix alcohol with prescription pain medication. Additionally, the combination of alcohol and over-the-counter pain medications can cause damage to the liver and kidneys.3
In addition to the medical risks, there are also mental health risks. Alcohol is a central nervous system depressant. Although it initially triggers a release of dopamine, leading to pleasant feelings, its long-term effects can leave you depressed.11 Alcohol use also causes inflammation in your body and brain, which is linked to depression.13
Alcohol causes symptom suppression; it does not lead to sustained healing. Although you may experience temporary relief, it is at the cost of physical and psychological recovery that you might experience if you focus treatment on the cause of your chronic pain and management of your symptoms.
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Help is standing by 24 hours a day, 7 days a week.Who Answers?How Are Alcoholism and Chronic Pain Treated?
If you have developed an addiction to alcohol, you may need addiction treatment in addition to treatment for your pain. MRI studies show significant overlap in the areas of the brain impacted by addiction and chronic pain.6 Because of this, there is beneficial overlap in simultaneous treatment to manage pain symptoms and encourage progress in addiction recovery.
Types of therapies used to address the needs of individuals with both a substance use disorder and a history of chronic pain include the following.
Trauma Therapies
Trauma therapies, such as eye movement desensitization and reprocessing (EMDR) and other exposure therapies, can support chronic pain treatment and addiction recovery.
Compassion-Based Treatment
Individuals involved in compassion-based practices report decreased instances of chronic pain.7 The social support involved in addiction recovery provides a community of compassionate people sharing their experiences and supporting you on your journey. Additionally, mindfulness-based stress reduction practices incorporate compassion as a key principle and have been shown to reduce chronic pain. 1
Somatic Therapies
Somatic experiencing therapy and holistic body-focused treatments such as trauma-sensitive yoga, biofeedback, and massage are all used in recovering from addiction, trauma, and chronic pain.4, 5
These therapies support a healthy relationship between the mind and body, a core factor in managing chronic pain. Somatic modalities teach ways to address physical and mental health symptoms through grounding, breathing exercises, and other techniques that may reduce the frequency and intensity of chronic pain and PTSD symptoms.
Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) explores the relationship between your beliefs, emotions, and behaviors. Your beliefs about your pain can increase or decrease your stress, impacting your perception of your chronic pain and the alcohol use behaviors that result. CBT helps you to reframe unhelpful belief systems into ways of thinking that empower you.4, 15
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Help is standing by 24 hours a day, 7 days a week.Who Answers?Pharmaceutical Treatment
Medication may help manage your chronic pain symptoms.6, This type of pain management may include medication that reduces nerve pain, such as SNRIs (serotonin and norepinephrine reuptake inhibitors).11
The effects of alcohol on chronic pain can significantly impact your quality of life. Treating your underlying pain is a process and will involve collaboration with your medical doctor.
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Resources
- Stahl, B. & Goldstein, E. (2010). A Mindfulness-Based Stress Reduction Workbook. New Harbinger Publications.
- Barnard, N. (1998). Foods that Fight Pain, Revolutionary Strategies for Maximum Pain Relief. Random House, Inc.
- Zale, E. L., Maisto, S. A., & Ditre, J. W. (2015). Interrelations between pain and alcohol: An integrative review. Clinical psychology review, 37, 57–71.
- Kaplan, G. (2014). Total Recovery, How We Get Sick, Why We Stay Sick, How We Can Recover. Rodale, Inc.
- Esmonde-White, M. (2016). Forever Painless, End Chronic Pain and Reclaim Your Life in 30 Minutes a Day. Harper Wave, an Imprint of Harper Collins Publishers.
- Przekop, P. (2015). Conquer Chronic Pain, An Innovative Mind-Body Approach. Hazelden Publishing.
- Darnall, B. (2021). Opening the Medicine Box in the Mind: The Psychology of Pain [Video]. YouTube.
- Levine, P.A. (2005). Healing Trauma, A Pioneering Program for Restoring the Wisdom of Your Body. Sounds True, Inc.
- Mate , G. (2008). In the realm of hungry ghosts: Close encounters with addiction. Toronto: Knopf Canada.
- Pierce, J. (2019). The Role of Early Life Trauma in Chronic Pain Patients. [Video].
- Miller, W.R., Forcehimes, A.A., Zweben, A. (2011). Treating Addiction: A Guide for Professionals. The Gilford Press.
- Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: a complex comorbidity. Science & practice perspectives, 3(1), 13–21.
- Weil, A. (2011). Spontaneous Happiness. Little, Brown and Company.
- Askay, S. W., Bombardier, C. H., & Patterson, D. R. (2009). Effect of acute and chronic alcohol abuse on pain management in a trauma center. Expert review of neurotherapeutics, 9(2), 271–277.
- Mills, S., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anesthesia, 123(2), e273–e283.