Question: Why is alcohol such an effective physical painkiller in chronic diseases such as arthritis? Lack of mobility associated with such conditions affects not just physical but mental health, which, along with other stressors, adds to the attractiveness of drinking for its relaxing impact. What is it in alcohol that produces these effects?
Answer: People generally drink alcohol to experience two main recreational drug effects: the opioid high and an anti-anxiety effect. But you are correct in noting that alcohol also has a meaningful impact on pain. Indeed, researchers believe some older adults may increase their drinking as they age because it reduces pain.
For example, a Californian study found that 22% of adults aged 75-85 used alcohol to manage pain. But is there a problem with using alcohol for pain reduction?
Alcohol stimulates opioid receptors in the brain, producing an opioid effect in the drinker of pleasure, tranquillity and euphoria – not too dissimilar to heroin or morphine.
Its anti-anxiety or calming effect comes from its stimulating influence on GABA receptors, producing feelings of disinhibition and relaxation, somewhat similar to taking diazepam (Valium). However, although small amounts of alcohol produce relaxation, heavier drinking can deplete GABA, increase tension, and induce panic.
Unfortunately, these positive effects can reinforce alcohol use, leading to misuse and resulting harm.
Medications such as naltrexone, used to help heavy drinkers reduce their intake, reduce the pleasure and relaxation produced by alcohol, thus limiting its reinforcing effects.
Alcohol is also a depressant that acts at the central nervous system level, depressing our body systems in a manner very similar to a range of anaesthetic agents. If alcohol is consumed recklessly, this depression of the central nervous system can stop our breathing, leading to death.
Alcohol also has analgesic effects for short-term pain, a 2017 review in the Journal of Pain noted. It has a small effect on pain threshold, so it slightly increases the point at which you feel pain from a given stimulus. And it has a moderate to large effect on ratings for pain intensity.
The mechanism by which alcohol induces its analgesic effect is not entirely clear. But studies in animal models suggest it may inhibit the transmission of signals from the stimuli or injury to the brain by binding to specific receptors on the spinal cord.
Unfortunately, several hidden harms exist when using alcohol for pain relief, particularly in older adults who are physiologically less able to process it.
For starters, there is the potential for alcohol misuse to occur, leading to injuries, violence, and alcohol poisoning. For example, alcohol-related injuries are not limited to young men crashing cars. Alcohol use is also a significant factor in injuries among older adults from falls, which can cause death.
And even drinking small to moderate levels of alcohol can harm physical health. For instance, drinking during pregnancy can cause fetal alcohol spectrum disorders in the unborn child. Alcohol increases the risk of numerous cancers, including breast, mouth, throat, oesophagus, voice box, liver, colon and rectal. Its use is also associated with long-term conditions such as liver disease, pancreatitis, stroke and high blood pressure.
Alcohol accounted for 1.78 million deaths globally in 2020 and was the leading risk factor for mortality among males aged 15-49 years, according to the Global Burden of Disease study.
In New Zealand, studies have found half of alcohol-related deaths were due to injuries, and 24% of alcohol-related deaths were due to cancer. The critical issue is that the ethanol found in alcoholic drinks is a human carcinogen, classified by the International Agency for Cancer Research.
So, although alcohol produces feelings of pleasure and calmness and can reduce pain, its misuse can reverse these initial positive effects, and it comes with a host of potential health problems attached. It is therefore unsuitable for managing chronic pain, and doctors aim to find appropriate pain-management regimes for their patients that reduce reliance on alcohol.
Where to get help:
If it’s an emergency and you feel that you or someone else is at risk, call 111.
- General helpline: phone 0800 787 797, text 868
- Māori Helpline – kaupapa Māori support services: phone 0800 787 798, text 8681
- Pasifika Helpline – Pacific support services: phone 0800 787 799, text 8681
- Youth Helpline – support for working through issues affecting young people: phone 0800 787 984, text 8681
· Need to talk? Free call or text 1737 any time for support from a trained counsellor
