Increased pain sensitivity in alcohol withdrawal syndrome

Abstract

Withdrawal from analgesic and addictive substances such as opioids or ethanol is associated with increased sensitivity to sensory stimulation in animal models. Here, we investigated perception of innocuous and noxious thermal or electric stimuli applied to the left hand or sternum in 30 male patients undergoing withdrawal from alcohol, 30 male abstained alcoholics and matched controls. The alcohol withdrawal scale and the Banger score were obtained to estimate the severity of withdrawal. In addition, the Beck depression inventory was used to estimate the influence of depressive symptoms on pain perception. The data presented provide substantial evidence that subjects undergoing alcohol withdrawal show increased heat pain sensitivity. Interestingly, this effect was observed both on the left hand and sternum. Pain thresholds and tolerances of electric stimuli did not differ between groups. However, in a subgroup analysis, a higher sensitivity for electrical pain thresholds and tolerances was observed in those patients that were identified to require pharmacological treatment for withdrawal according to disease severity. Furthermore, the perceived painful thermal and electrical sensation was substantially influenced by the affective state of patients. No differences were found between patients of the abstained group and control subjects for any pain parameter. In conclusion, we demonstrate withdrawal-induced hyperalgesia upon thermal stimulation in patients. Since the influence of affective symptoms on pain perception during withdrawal is remarkable, we assume that peripheral and central mechanisms might account for this finding, which should be assessed in detail in future studies.

Physical Pain in Alcohol-Dependent Patients Entering Treatment in Poland—Prevalence and Correlates

“…These additional analyses highlight the potential that, even among the select group of adults being treated for alcohol dependence, those with more severe alcohol dependence are more likely to experience at least some level of pain compared to those with less severe alcohol dependence. As noted previously in the literature, prolonged alcohol use and/or withdrawal may lead to hyperalgesia or an increased sensitivity to pain (Gatch, 2009;Jochum et al, 2010). It is possible that even mild pain could place someone at greater risk for continued alcohol use and perpetuate the cycle of drinking and alcohol dependence in the period preceding entry into alcohol treatment.…”

“…Emerging data indicate that prolonged alcohol use and/ or withdrawal may lead to hyperalgesia or an increased sensitivity to pain (Gatch, 2009;Jochum et al, 2010). In addition, alcohol-dependent individuals who report that they use alcohol to cope with pain tend to have worse alcohol-related outcomes over time (Brennan et al, 2005).…”

Alcohol and Migraine: What Should We Tell Patients?

“…Rats that received dural stimulation followed by alcohol showed an initial analgesic effect within the first 2 h after alcohol ingestion, but 4-6 h later, their pain sensitivity increased. Similarly, experiments in humans have shown that intravenous alcohol has an analgesic effect with increased pain sensitivity found in alcohol withdrawal [30,31].…”

Centrally-mediated sensory information processing is impacted with increased alcohol consumption in college-aged individuals

“…Sensory assessments of individuals with alcoholism, in particular assessments of vibration thresholds, thermal sensitivities, and pain tests, have provided useful metrics in detecting and describing alcoholic peripheral neuropathy (Hilz et al, 1994(Hilz et al, , 1995Jochum et al, 2010;Sosenko et al, 1991;Yarnitsky and Zaslansky, 1998). Additionally, impairment in central neural mechanisms in individuals with alcohol use disorders has been implicated by studies describing abnormal inhibition of sensory gating; reports have demonstrated that thalamocortical feed-forward interactions modulate sensory information processing (Wang et al, 2010), as well as disinhibition of sensory evoked potential recovery patterns (Marco et al, 2005;Mochizuki et al, 2004).…”