False Remedy: The Alcohol Paradox in Chronic Pain Management

Chronic pain affects about one in every three adults, and many of these individuals seek relief in a widely available substance: alcohol. What few people realize is that this shortcut may conceal a biological trap capable of turning temporary pain into prolonged suffering and opening the door to alcohol use disorder.¹

Research shows that up to 38% of heavy drinkers report using alcoholic beverages to relieve physical pain.¹ And this phenomenon is not merely cultural: scientific studies confirm that alcohol does, in fact, have some analgesic effect. The crucial detail, however, is that this relief only appears at high doses — around 0.08 g/dL of blood alcohol concentration — the same level that characterizes binge drinking, defined as four or more drinks on a single occasion for women and five or more for men, a pattern associated with several diseases and health complications such as cancer, hypertension, and alcoholism itself.² ³

The problem is that this analgesic effect is brief and deceptive. Within just a few hours after consumption, acute tolerance sets in: the body responds less and less to the same amount of alcohol. Even worse, as alcohol leaves the system, sensitivity to pain does not simply return to normal — it may become amplified in a phenomenon known as hyperalgesia. In other words, the next day, or during periods of abstinence, a person may feel more pain than they would have if they had never consumed alcohol in the first place.¹

Alcohol provides temporary comfort from pain but leaves the individual even more vulnerable shortly afterward. The brain quickly learns that “another drink” may bring relief, creating an urge to drink again, in increasingly larger amounts and at increasingly shorter intervals.¹ ⁴

Over time, intense and prolonged alcohol consumption causes lasting changes in the central nervous system, making the brain more sensitive to pain (a process called central sensitization) and potentially causing direct damage to peripheral nerves, known as alcoholic neuropathy. It is no coincidence that people with alcohol use disorder report chronic pain at much higher rates (43% to 54%) than those who drink little or not at all (28% to 33%).¹ What began as an attempt to cope with pain becomes, itself, a new source of suffering and a major obstacle to recovery, since higher levels of pain are associated with a greater risk of relapse among those seeking treatment.¹

The good news is that effective and safe alternatives do exist. Psychological approaches such as cognitive behavioral therapy (CBT) and mindfulness-based interventions have shown promising results in the combined management of pain and alcohol consumption.¹ Certain medications already used in the treatment of alcohol use disorder, such as naltrexone, topiramate, and gabapentin, may also have beneficial effects on chronic pain and can be valuable options when prescribed by a healthcare professional. Recognizing that alcohol is not a remedy for pain and seeking proper medical evaluation to treat the underlying problem is the first step toward breaking free from this cycle.

References:

1. De Aquino, J. P., Sloan, M. E., Nunes, J. C., Costa, G. P. A., Katz, J. L., de Oliveira, D., Ra, J., Tang, V. M., & Petrakis, I. L. (2024). Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic. The American Journal of Psychiatry, 181(5), 391–402. https://doi.org/10.1176/appi.ajp.20230886
2. Thompson, T., Oram, C., Correll, C. U., Tsermentseli, S., & Stubbs, B. (2017). Analgesic Effects of Alcohol: A Systematic Review and Meta-Analysis of Controlled Experimental Studies in Healthy Participants. The Journal of Pain, 18(5), 499–510. https://doi.org/10.1016/j.jpain.2016.11.009
3. Cucinello-Ragland, J. A., & Edwards, S. (2023). The hidden risks of alcohol use for pain relief. Alcohol, clinical & experimental research, 47(2), 209–210. https://doi.org/10.1111/acer.15005
4. Edwards, S., Vendruscolo, L. F., Gilpin, N. W., Wojnar, M., & Witkiewitz, K. (2020). Alcohol and pain: A translational review of preclinical and clinical findings to inform future treatment strategies. Alcoholism: Clinical and Experimental Research, 44(2), 368–383. https://doi.org/10.1111/acer.14260