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Nociplastic Pain and Pain-Motivated Drinking in Alcohol Use Disorder

PainSci » bibliography » Hall et al 2024
Tags: etiology, fibromyalgia, counter-intuitive, pro, chronic pain, pain problems

One article on PainSci cites Hall 2024: A Rational Guide to Fibromyalgia

PainSci notes on Hall 2024:

This study showed that pain-motivated drinking appears to be motivated more strongly by “weird” pain — chronic and unexplained pain, or “nociplastic” pain — than by other kinds of of pain. Not all pain of this kind fits under the umbrella of fibromyalgia, but a lot of it does, and that’s what Hall et al. focused on. Specifically, people with the combination of alcohol use disorder and fibromyalgia scored about 40% higher on a pain-motivated drinking scale than with other kinds of pain (3.4 out of 5 versus 2.4).

The top-scoring reasons people gave for drinking for pain? With fibromyalgia: “to move better or get things done.” For everyone else: “To forget” the pain. But all reasons given were ranked a good bit higher by fibromyalgia patients, and that’s the story here.

People certainly drink to cope with chronic pain: there’s been plenty of research about that over the years, and it seemed rather obvious before it was ever put under a microscope. But this is probably the first study to show that drinking-for-pain seems to vary with the underlying problem … and not just because some kinds of pain are more intense. Indeed, pain intensity specifically does not explain it: it really is the type of pain that’s motivating more drinking, more than higher intensity pain of any type. For instance, you’re more likely to drink for mild fibromyalgia than savage sciatica.

This drink link also sticks around even after ruling out anxiety and depression. They are common ingredients in the chronic pain stew, of course, but Hall et al. report no clear pattern of more drinking with more anxiety/depression.

The link could be causal in either direction, and the authors were particularly interested in the hypothesis that excessive drinking might actually cause nociplastic pain. But there are of course other potential factors that could also explain the correlation. For instance, measurements of neuroticism or ADHD could be.

For more context, see my blog post about this study.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Heavy chronic alcohol use may produce pain amplification through neurochemical and neuroplastic changes at multiple levels of the nervous system. Similar changes are thought to underlie nociplastic pain. The American College of Rheumatology Fibromyalgia Survey has been used as a surrogate for nociplastic pain, including among individuals with alcohol use disorder (AUD). However, studies linking nociplastic pain to pain-motivated drinking are lacking. The present study aimed to determine if nociplastic pain is associated with pain-motivated drinking in AUD. To achieve this aim, a new scale—the Pain-Motivated Drinking Scale (PMDS)—was developed to measure how often participants were motivated by pain to drink alcohol. Measurement properties of this new scale were determined, including its factor structure, internal consistency reliability, and construct validity. In this cross-sectional observational study, participants with AUD (n = 138) were consecutively recruited from the patient pool at an academic addiction treatment facility. Seventy-two percent (95, 72.0%) reported they drank alcohol "to get relief from physical pain" at least some of the time, and over forty-two percent (56, 42.4%) reported pain relief motivated their drinking at least half of the time. PMDS had a single-factor structure, strong internal consistency reliability, and construct validity. A multiple hierarchical linear regression was run to determine if nociplastic pain was associated with pain-motivated drinking. Nociplastic pain was associated with PMDS even after controlling for potential confounders and pain severity. These findings suggest nociplastic pain is uniquely associated with pain-motivated drinking in AUD. PERSPECTIVE: Nociplastic pain is independently associated with pain-motivated drinking in alcohol use disorder (AUD). The Pain-Motivated Drinking Scale (PMDS) is a new scale to measure how often people drink to cope with pain. PMDS has promising psychometric properties. Nociplastic pain may be uniquely associated with pain-motivated drinking in AUD.

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