Alcohol and pain in the population

Alcohol and pain in the population – BodyInMind – Comfortably numb – January 22, 2017

There is a problem in observational epidemiology. If a disease has an association with a behaviour within the population, we cannot tell which of these is true:

  1. the behaviour causes the disease;
  2. the disease causes the behaviour; or
  3. a third factor causes both.

The first instinct for the reader of an epidemiological study is often to infer that the behaviour causes the disease with which it is associated.

This is what gives rise to newspaper headlines warning of everyday items that cause or cure cancer.  

A second instinctual and opposite reaction is to recite the response ‘correlation is not causation’ and to dismiss the result.

Both of these responses however would be wrong. There is always some causal relationship (that is a ‘reason’) behind an association and it is our job as researchers to try to determine exactly what the causal relationship is.

One such result from observational epidemiology that we and others have found is that those who drink alcohol are less likely to report chronic pain.

Furthermore, among those who do have chronic pain, those who drink alcohol are less disabled by the pain, have less severe symptoms and better quality of life.

The newspaper headline response to these findings might be Alcohol helps cut disability caused by chronic pain’

more sceptical response would be ‘correlation is not causation’, and that this is a spurious and ridiculous finding.

Our response was rather, “Well, if we can’t necessarily conclude that alcohol is preventing people from reporting pain, what is the causal relationship behind these findings?”

To that end, we looked at the drinking habits and pain reporting in data collected from the UK Biobank

The UK Biobank is a large (over ½ a million participants) repository of data, including self-report data on a wide range of behaviours including diet, smoking, activity, and alcohol consumption, and both self-report and medical record data on disease outcomes

We were particularly interested in those people who had chronic pain all over the body. We were then able to look at whether people who drank less were more likely to report having chronic pain all over the body — and they were.

Apart from the problems of sampling error (which was overcome by having such a big sample) and measurement error (can people reliably report how much pain they have had? or how much alcohol?) there is a clear relationship between alcohol and pain.

What we wanted to know was:

could it be possible that those who did not drink were more likely to report pain because they had stopped drinking due to ill health?

We haven’t been able to show that alcohol helps people with pain or not.

My guess is that drinking alcohol is an indicator of good health – people drink to the extent that their health allows them, and they reduce their alcohol intake to the extent that they are prone to ill health and pain.

Again, here is the assumption that all pain is the same – and that could not be further from the truth.

No one is conducting studies comparing different kinds, types, or locations of pain, which leaves a wide gap in our knowledge about pain and its relief.

From personal past experience, I know that alcohol can ease some kinds of acute pain, but my chronic pain was always unaffected. Now that I’m taking opioids for my pain, I generally avoid drinking at all because it’s such a dangerous combination and only makes me sleepy.

So, if you know someone who is having problems with pain, it would definitely be unwise to advise them to have a drink – but if you know someone who avoids drinking altogether, it could be an idea to ask them if they have any problems with pain.

Author: Marcus Beasley
Marcus is a study coordinator with the Epidemiology Group at the University of Aberdeen in Scotland. His research interests include methodology in the epidemiology of chronic pain, particularly non-specific effects in trials of treatments for pain. He is currently working on recruitment for the MAmMOTH Study, a trial of CBT for the prevention of chronic widespread pain
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One thought on “Alcohol and pain in the population

  1. Kahty C

    This is interesting. There seem to be a lot of people, who drink and have underlying pain. There are some that drink, really excessively, but would not take Pain Medications They are afraid of becoming “Addicted.” Of course the scale of pain, and alcohol consumption range from a little Drink in the evening to for the “Lumbago” to full blown Alcoholism. So many people die from too much Alcohol, a particularity nasty and expensive disease in itself. There does not seem to be much focus on those numbers.
    There also is no Media campaign about the “horrors’ of alcohol. The long term effects of alcohol Abuse, are apparently not as sensationalistic and the Opiate Coverage. The Time and expense to the Medical System, Police Interventions, are not mentioned. I live in a community with a lot of Alcohol abuse problems. The Media only mentions Drunken Driving, just one of the problems. They downplay the correlation with domestic abuse, child neglect, and E.R Usage. They don’t do any “Studies” on the correlation with untreated pain. Most real Alcohols prefer, Alcohol to Opiates.
    There seems to be an unspoken and uncounted “Epidemic” of Seniors drinking themselves to death. They just have not done any research, or counted the number of the dead. Physicians barely acknowledge the problem. They prescribe the range of other drugs, including NSAIDs, which when combined with Alcohol, can hasten the death process. This is just one combination, that can be deadly, they can cause Alcoholics to “Bleed Out.” The combination of Alcohol and NSAIDs, seems to be a fairly common but uncounted cause of death. One more cause of death that is uncounted, or under-counted. The loose reporting requirements, that they use for Data collection, do not capture the true scope.
    There is a pattern here. They use numbers had data to influence healthcare Policy. Powerful Industry Lobbying Groups found that this information was not good for Business. They even severely under-counted the numbers of people who die from Diabetes, a significant health problem. They were able to manipulate Public Opinion, and keep the current dysfunctional Health Industry going by interfering with the Reporting requirements, they had to keep the public in the dark. we thought that the “Computer Age’ and massive amounts of Data, were going to be used Scientifically, instead it is all based on “Opinion.” The Corporate Media, which Advertises and Profits from ignorance is misdirecting our attention.

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