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Alcohol and Pain

Pain DURING Drinking Alcohol

Pain in the neck, jaw, chest, abdomen, shoulder, upper arm, or lower back pain, cough or itchiness that occurs within few minutes after drinking even small amounts of alcohol and lasts from several minutes to few hours may be the first symptom of Hodgkin lymphoma [1,2].

“Pain in the jaw,” an intense cramping pain below the ears soon after starting drinking during a meal, is probably due to irritation of the parotid gland caused by the back-flow of alcohol through the salivary ducts triggered by chewing food. Pain under the jaw speaks for the irritation or inflammation of the submandibular gland [3].

Shooting pain in the side (flanks, loin) or “lower back pain” after drinking alcohol or high amount of fluid may be caused by increased urine flow in individuals with the obstruction of the upper urinary tract (kidneys, ureters) due to genetic disorders, such as pelvi-ureteric junction (PUJ) obstruction, kidney inflammation or infection, kidney or other abdominal tumor or other causes [4].

Upper middle abdominal pain (epigastric pain) triggered by strong alcoholic beverages may occur in individuals with acute gastritis [5]stomach ulcer [6] or chronic pancreatitis [7].

Pain AFTER Drinking Alcohol

Abdominal pain:

Crampy abdominal pain, bloating, belching, constipation or diarrhea after drinking alcohol, especially after carbonated alcoholic beverages (beer) and liqueurs may be symptoms of irritable bowel syndrome (IBS) [8].

In alcoholics with chronic pancreatitis, heavy drinking can cause acute pancreatitis with sudden, severe pain in the upper middle abdomen (epigastric pain) and nausea [5,9].

Chest pain:

Heartburn (pain behind the breastbone) after drinking may be due to gastro-esophageal reflux [14].

Sudden pain in the lower middle chest after vigorous vomiting may be caused by a tear in the esophageal mucosal lining (Mallory-Weiss syndrome) [10].

Severe chest pain that occurs 1.5-17.5 hours after stopping drinking and lasts for 5-30 minutes, may be caused by a spasm in either healthy or atherosclerotic coronary arteries (variant or Prinzmetal angina) [11].

Joint pain:

Alcohol can trigger or worsen pain in patients with gout [12,13].

CHRONIC, RECURRING Alcohol-Related Pain

Upper middle or left abdominal pain, aggravated by alcohol, other fluids or food, which lasts for several hours or is persistent, may be a symptom of chronic pancreatitis or pancreatic cancer [7].

Burning pain in the soles of the feet (burning feet syndrome) in chronic drinkers may be due to nerve damage caused by vitamin B1 (thiamin) deficiency (“dry beri-beri”) [15,16,17].

Slowly developing pain in the knees, hips, groin buttocks, thighs, shoulder, upper arm, hands or feet in chronic alcoholics may be due to bone damage (osteonecrosis or avascular necrosis) [18,19,20]. Diagnosis may be confirmed by magnetic resonance (MRI) [21].

Alcohol as a Painkiller

Alcohol stimulates the release of endogenous opioids in the brain thus causing pain relief and the feeling of well being [22]. Endogenous opioids may reach maximal levels within 30 minutes of alcohol consumption and then start to decline despite persisting high blood alcohol concentrations [23]. Some people with chronic disorders, such as cancer, arthritis or chronic tooth pain, drink alcohol to relieve pain [24]. This may lead to alcohol addiction and — even more pain over the time [25]. People who regularly drink may develop tolerance to the analgesic effect of alcohol, so they need to drink more to achieve the same effect.

  • In one 1976 study, whiskey reduced pain in alcoholics, but not in non-alcoholics; this could be due to expectation of the pain-relieving effect by alcoholics, but not non-alcoholics [26].
  • In one 1988 study, the amount of alcohol equivalent to 4 drinks drunk by a 160 lbs [73 kg] man, probably resulting in blood alcohol concentration about 0.1 g/100 mL blood, increased the tolerance to pain to about the same extent as 12 mg of morphine [27].
  • A person with blood alcohol concentration above 0.2 g/100 mL blood may not feel the pain after injury; this could happen when a 160 lbs person would have 9 or more drinks, which is 9 x 12 oz 4% beer, 45 oz [1.35 liter] 12% wine, or 13.5 oz [400 mL] 40% spirit, in one hour on an empty stomach [29].
  • A highly intoxicated person with the blood alcohol concentration above 0.35 g/100 mL blood might have an absent sensitivity for pain and touch (surgical level anesthesia); this could happen when a 160 lbs person would have 15 drinks, which is 15 x 12 oz 4% beer, 75 oz [2.2 liters] 12% wine, or 22 oz [650 mL] 40% spirit or more, on an empty stomach in one hour [28].

  1. Bobrove AM, 1983, Alcohol-related pain and Hodgkin disease  PubMed Central
  2. Atkinson K et al, 1976, ALCOHOL PAIN IN HODGKIN’S DISEASE   Wiley Online Library
  3. Okany CC et al, 1990, Submandibular chronic sialadenitis presenting with alcohol-induced pain  Postgraduate Medical Journal – BMJ
  4. Urinary tract obstruction  Patient.info
  5. Wehbi M, 2014, Acute Gastritis Clinical Presentation  Emedicine
  6. Stomach ulcer treatment  NHS Choices
  7. Chronic Pancreatitis  PubMed Health
  8. Irritable bowel syndrome (IBS) – Symptoms  NHS Choices
  9. Acute pancreatitis  Patient.info
  10. Song LMWK, 2015, Mallory-Weiss Tear Overview of Mallory-Weiss Syndrome  Emedicine
  11. Takizawa A et al, 1984, Variant angina induced by alcohol ingestion  PubMed
  12. Zhang Y et al, 2006, Alcohol consumption as a trigger of recurrent gout attacks  PubMed
  13. Gout  Patient.info
  14. Shao-sua C et al, 2010, Is alcohol consumption associated with gastroesophageal reflux disease?  PubMed Central
  15. Oscar-Berman M, 1997, Impairments of Brain and Behavior; The Neurological Effects of Alcohol  National Institute on Alcohol Abuse and Alcoholism
  16. Touge T et al, 1998, Painful legs and moving toes” and muscle cramps spreading to the bilateral legs in a patient with alcoholic polyneuropathy  PubMed
  17. Ramachandran TS, 2015, Alcohol (Ethanol) Related Neuropathy Clinical Presentation  Emedicine
  18. 2013, Questions and Answers about Osteonecrosis (Avascular Necrosis)  National Institute of Arthritis and Musculoskeletal and Skin Diseases
  19. Levine M, 2013, Hip osteonecrosis  Emedicine
  20. Avascular necrosis symptoms  Mayo Clinic
  21. Levine M, 2013, Hip osteonecrosis workup  Emedicine
  22. Froehlich JC, 1997, Opioid peptides  National Institute on Alcohol Abuse and Alcoholism
  23. Ginaoulakis C, 1993, Endogenous Opioids and Excessive Alcohol Consumption  PubMed Central
  24. Ilgen M, Chronic pain in patients with alcohol or drug use  disorders  State of Michigan
  25. Brennan PL et al, 2005, Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers  PubMed
  26. Cutter HS et al, 1976, “Feeling no pain” differential responses to pain by alcoholics and nonalcoholics before and after drinking  PubMed
  27. Woodrow KM et al, 1988, Feeling no pain: alcohol as an analgesic  PubMed
  28. Alcohol Problems in Intimate Relationships: Identification and Intervention  National Institute on Alcohol Abuse and Alcoholism
  29. Frequently Asked Questions Students Ask Us About Alcohol at UNH  University of New Hampshire

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