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Fibromyalgia drives people to drink

 •  • by Paul Ingraham
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Or does drink drive people to fibromyalgia?

That’s going to be tough to sort out, but we do know one new thing about it, thanks to a new study: people with alcohol use disorder drink more to self-medicate fibromyalgia than other kinds of pain. Regardless of intensity. Or anxiety or depression.

The new study, by Hall et al., shows that pain-motivated drinking is motivated quite a bit 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 they 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).

Note that drinking is quite a common method of self-medication, although hardly universal. Many people with fibromyalgia feel so sensitive to alcohol that they don’t drink at all, or very conservatively.

The top-scoring reasons people give 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.

Photo looking down into a glass of whiskey with a “no entry” symbol at the bottom of the glass.

Some kinds of pain motivate more drinking than others. And the drinking might also be making the pain worse.

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.

There’s just something about fibromyalgia!

This drinking-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.

So what direction is the arrow of causality pointing? That’s the big question this cannot answer, as usual. There are four major possibilities:

  • Maybe this kind of pain makes people more desperate to anaesthetize themselves because it’s uniquely unpleasant in quality, even when it’s milder.
  • Or maybe alcohol came first, and the drinking actually screws with some people’s neurology and makes the problem … and then the drinking escalates as it starts to become a coping mechanism as well, a vicious cycle. Certainly that’s a familiar kind of pattern with drugs of all kinds! (Or maybe alcohol cannot actually create fibromyalgia, but it can still make it worse.)
  • Maybe both weird pain and alcohol use disorder are symptoms of deeper physiological problems — things that make us more vulnerable to both alcoholism and pain. There are quite a few possibilities, and it doesn't seem unlikely. Physiology is more than complex enough for such tangled and subtle relationships.

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