Understanding Chronic Pain

Substance Abuse

[From Chapter 12 of Understanding Chronic Pain]

The most commonly used drug is ethyl alcohol. It produces a pleasant sense of relaxation and disinhibition, this we believe by stimulating GABA receptors. Used in moderation, it probably has no long-term adverse effects. In excess it is toxic to neural tissue. This may manifest as peripheral neuritis with numbness, tingling, and sometimes pain in the extremities. Less common is cerebellar degeneration with ataxia due to destruction of the brain's balance center. Occasionally a portion of the limbic system may be selectively destroyed, producing memory loss, alcoholic dementia.

Alcohol is a drug of abuse, and it has the capacity in those perhaps genetically predisposed to produce addiction. Abstinence from the drug in those dependent upon it will invoke withdrawal, tremors, convulsive seizures, or delirium tremens. There is another withdrawal effect, not so widely recognized, and that is painfulness. It usually appears within a short interval following alcohol withdrawal, a few weeks or months, but it may occur years later. This is not unlike the occurrence of delirium tremens. That disorder typically comes within a week or two of withdrawal, but in exceptional cases it may appear many years later just as it did with Harry. In his case delirium tremens occurred in time remote from his alcohol withdrawal under the provocation of a stressor, carcinoma of the esophagus.

The resiliency and redundancy of our neural systems allow us, most of the time, to compensate and override potentially maladaptive behaviors. This is quite evident in alcoholism. Most can enter abstinence without major withdrawal. However, if there is an intercurrent stressor such as pneumonia or hip fracture, delirium tremens occurs with great predictability. A combination of stressors overwhelms the body's capacity for defense. This may account for the occurrence of painfulness after alcohol withdrawal. There are often concurrent stressors, sometimes depression and sometimes corporal injury from which the patient fails to recover.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:26 AM

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