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Dual effect of alcohol on pain in rheumatoid arthritis

  • University of Twente Faculty Behavioural Management and Social Sciences
Chapter 9 ESR and outdoor temperature in RA 110
Wieb Patberg 1985 Paalkoepel, Paterswoldse Meer Ets 14/50
Chapter 10
Dual effect of alcohol on pain in
rheumatoid arthritis
Wiebe R. Patberg, Johannes J. Rasker, and Albert van de Wiel
Department of Physiology, University of Groningen, The Netherlands
Department of Rheumatology, Twente Hospital, Enschede, The
Department of Internal Medicine, Eemland Hospital, Amersfoort, The
Journal of Rheumatology 1999; 26: 1215
Chapter 10 Alcohol and RA 112
Chapter 10 Alcohol and RA 113
To the Editor:
Due to its analgesic effects, alcohol can diminish joint pain, one of the
symptoms of rheumatoid arthritis (RA). However, both relief from, and
aggravation of, joint pain have been reported from patients with RA in
relation to alcohol use (Bradlow & Mowat 1985, Blaze-Temple et al.
1992). This inconsistency might be explained by a delayed worsening
effect of alcohol on RA pain in addition to short-term alleviation of
Figure 1 Plot of correlation coefficient for the relation between daily alcohol intake and joint pain
score in a patient with RA (: p < 0.001). Pain score data were time shifted from -20 to
+40 days with respect to alcohol intake data.
One of the authors (WRP), a 51-year-old man with RA since 1979 satis-
fying American College of Rheumatology criteria (Arnett et al. 1988),
and with positive rheumatoid factor, quantified his daily joint pain (602
scores) as described earlier (Patberg 1989) for 3 years (1994-1996). Daily
joint pain was found to correlate positively with the daily number (range
-20 -10 0 10 20 30 40
phase shift (days)
correlation coefficient (r)
Chapter 10 Alcohol and RA 114
0-5) of alcoholic beverages taken (885 scores) during the 3 years (Figure
1, at phase shift 0 days). The correlation gradually increases when the
pain score data are shifted back in time with respect to the alcohol data,
reaching a maximum at a phase shift of 8 days (r = 0.22, p < 0.001).
This indicates that alcohol intake is followed by an increase in joint pain
8 days later on the average. It might be argued that this finding is related
to the positive correlation between RA pain and the meteorological
temperature and humidity (Patberg 1989), e.g. as a result of drinking
more beer in summer. However, correlation of the alcohol intake with
these weather factors during 1994-1996 shows a negative relationship,
indicating independent influences of weather and alcohol.
The negative peak (Figure 1, arrow) found at a phase shift of 1 day illus-
trates the analgesic effect of alcohol: alcohol intake in the evening low-
ers the joint pain score determined on the following morning.
Although other constituents of the alcoholic beverages taken (mostly
beer and Dutch gin) may play a role, we consider that it is the alcohol
that affects the pain. The effect of alcohol on the disease itself is unclear.
A lowered production of corticosteroids due to the blunting effect of
alcohol on the ACTH response may play a role. It seems clear, how-
ever, that apart from the short-term analgesic effect, alcohol worsens
joint pain in RA.
Chapter 10 Alcohol and RA 115
Bradlow A, Mowat AG 1985. Alcohol consumption in arthritis patients: clinical and labo-
ratory studies. Ann Rheum Dis 44: 163-168.
Blaze-Temple D, Barrett T, Howat P, Binns CW 1992. Arthritis outpatients: disability,
pain and alcohol use. Aust J Public Health 16: 287-293.
Arnett FC, Edworthy SM, Bloch DA, et al. 1988. The American Rheumatism Association
1987 revised criteria for the classification of rheumatoid arthritis. Arthritis
Rheum 31: 315-324.
Patberg WR 1989. Effect of temperature and humidity on daily pain score in a patient
with rheumatoid arthritis [letter]. Arthritis Rheum 32: 1627-1629.
... The association between pain and alcohol use is clearly complex, and the mechanisms of comorbidity of chronic pain and AUD are not well understood in humans. There is a literature examining analgesic effects of alcohol (Chung and Wang, 2013;Hill et al., 2018;Patberg et al., 1999;Thompson et al., 2017;Woodrow and Eltherington, 1988), and recent empirical work has found acute pain increases the urge to drink (Moskal et al., 2018). Further, preliminary work indicates greater alcohol consumption is associated with momentary reductions in pain (Carpenter et al., 2018). ...
Alcohol use disorder (AUD) and chronic pain are enduring and devastating conditions that share an intersecting epidemiology and neurobiology. Chronic alcohol use itself can produce a characteristic painful neuropathy, while the regular analgesic use of alcohol in the context of nociceptive sensitization and heightened affective pain sensitivity may promote negative reinforcement mechanisms that underlie AUD maintenance and progression. The goal of this review is to provide a broad translational framework that communicates research findings spanning preclinical and clinical studies, including a review of genetic, molecular, behavioral, and social mechanisms that facilitate interactions between persistent pain and alcohol use. We also consider recent evidence that will shape future investigations into novel treatment mechanisms for pain in individuals suffering from AUD.
... Hazardous drinking is associated with depressive and anxiety disorders as well as suicide and domestic violence. The limited evidence base suggests that moderate or casual drinking is not associated with social or health hazards; any likely benefits of moderate drinking for mental health have not been studied in developing countries [13].Although alcohol use may have a beneficial effect on pain in rheumatoid arthritis, it is unlikely that this plays a role in BanglaDesh [14]. Currently, in developing countries alcoholrelated problems commonly result from trauma, violence, organ system damage, various cancers, unsafe sexual practices, injuries to the brain of the developing foetus and general poor nutritional status of families with a heavy drinking parent/parents [15,16]. ...
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Objectives: This study was aimed to determine the names and alcohol content or strength of different alcoholic beverages used in different parts of Bangladesh and also to determine contamination with heavy metals and bacteria in some samples. Methods: Eight different types of alcoholic beverages consumed in different parts of Bangladesh were collected and studied in the laboratory of Bangladesh Council of Scientific and Industrial Research (BCSIR). Before sending to the laboratory, samples were stored in a refrigerator at temperature 4-8 degree Celsius. In all samples, strength of ethanol content was studied. Among the samples, Dochuani and Tari was tested for heavy metal, Chubichi and Pochani studied for total viable micro-bacterial contamination. Results: In this study one sample was from Khagrachari (Hilly area) not been reported as manufacture site by the Department of narcotics control of Bangladesh before. Out of eight samples, one was of a Brand company (Keru & Co) and others homemade. Highest concentration, 81.56% was observed in Spirit followed by 37.7% in Dochuani and lowest 2.2% in Tari. Insignificant amount of heavy metal detected in Dochuani and Tari. There was no viable micro-bacterial contamination in samples tested. Conclusions: Without knowing the strength, people are using different types of homemade alcoholic beverages as such in a risk of health hazards as well as death. A national survey need to be conducted to obtain how many types of alcoholic beverages being manufactured, their strength and true picture of alcohol use so that strategy plan can be developed of its healthy use if needed at all.
Among 85 in-patients treated for alcohol and/or drug dependence, 52% reported that pain triggered a relapse of their substance dependence. Low- and medium-intensity pain (2 and 3 on five-point Melzack's scale) were the most important in this respect. Before treatment, most patients reported using a very limited number of strategies to cope with pain (1.4 on average), suggesting that patients may benefit from instructions in applying techniques to cope with pain. These techniques are in many respects similar to techniques to cope with drug/alcohol craving. During in-patient treatment, the patients' self-confidence to cope with pain increased. After treatment, patients reported their intention to use several pain-coping strategies; the most frequently reported strategies were distraction, suitable physical exercise, relaxation, medical care, lifestyle changes, and autosuggestion. Abuse of alcohol and other addictive substances may initially alleviate pain but would later on often aggravate it. The interactions between analgesics (including NSA) and alcohol are extremely risky. The experience with pain directly or indirectly related to substance dependence can be utilized as part of motivation enhancement therapy in the treatment of addiction.
The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
There is a small body of literature describing investigations into the relationships between pain and disabling conditions and alcohol consumption. Of these few studies, most have concluded that pain and disability are positively associated with alcohol consumption, though these particular studies have not been methodologically rigorous. Arthritis is the most prevalent of the disabling conditions, and one of the major symptoms of arthritis is pain. Several factors associated with the disease are thought to make arthritis sufferers particularly vulnerable to the use of alcohol for its mind-altering and analgesic properties. In the present study, conducted in 1987, a sample of 154 Perth arthritic outpatients were interviewed to investigate the relationship between pain, disability and alcohol consumption. Results showed that pain and disability scores were very weak predictors of volume of weekly alcohol consumption for males, but the relationship was in a negative direction. Results from a previous study were confirmed in the finding that being an ex-drinker was a predictor of a higher disability score for females. Fewer patients were drinkers than in the population at large and fewer drank at the level of the highest consumption category. However, the proportions of male and female patients drinking above NHMRC low risk levels were the same as the general population (age-standardised comparison). Most who considered themselves current drinkers said that alcohol did not help their pain, stiffness or weakness. Various possible explanations are offered for these results and recommendations for future research are presented.
In popular belief patients with chronic arthritis take alcohol for its analgesic effect. To test this we studied by validated questionnaire the past and present alcohol consumption of 103 patients with primary osteoarthritis of the hip (OA), 95 patients with rheumatoid arthritis (RA), and 90 orthopaedic non-arthritic controls. OA men were most likely and RA men least likely to have been heavy drinkers at any time of their lives. Mean red corpuscular volume (MCV), gamma-glutamyltransferase (GGT), and serum uric acid (SUA) levels did not correlate with reported alcohol consumption. Two of 93 OA femoral heads examined had avascular change; both were from heavy drinkers. The abstemiousness of RA men compared with their OA counterparts was due to a striking increase in joint pain after drinking alcohol (p = 0.004), fear of adverse drug reactions with alcohol, and a widespread belief not expressed by OA men that 'alcohol and arthritis do not mix'.
Arthritis outpatients: disability, pain and alcohol use The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis
  • Blaze
  • D Temple
  • T Barrett
  • P Howat
  • Cw Binns
  • Sm Edworthy
  • Bloch
  • Da
Blaze-Temple D, Barrett T, Howat P, Binns CW 1992. Arthritis outpatients: disability, pain and alcohol use. Aust J Public Health 16: 287-293. Arnett FC, Edworthy SM, Bloch DA, et al. 1988. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31: 315-324