Fibromyalgia and Alcohol Use


The term fibromyalgia comes from the Latin term for tissue (fibro) and the Greek terms for muscle (myo) and pain (algia). Fibromyalgia is a disorder that is characterized by chronic and widespread pain, tenderness, fatigue, and numerous other symptoms.

 

Even though it is characterized as a rheumatic disease and often considered to be an arthritis-like or arthritis-related condition, fibromyalgia is not a form of arthritis because it is not associated with damage or inflammation to the joints or other tissues in individuals who have it. Individuals diagnosed with fibromyalgia often have diffuse pain as well as significant and heightened painful responses to pressure.

Fibromyalgia is diagnosed based on an individual’s presentation and pain associated with 18 specific “trigger points” on the body that the diagnosing physician assesses and evaluates.  There remains some debate as to whether many of the symptoms associated with fibromyalgia represent a combination of both physical and psychosomatic issues. Many times, the disorder appears similar in its presentation to many different mental health disorders because those diagnosed with fibromyalgia often suffer from issues with chronic fatigue, lack of motivation, depression, issues with anxiety, extreme emotional reactions, trauma- and stress-related issues, and numerous other symptoms that resemble certain psychological disorders. It is not uncommon for individuals diagnosed with fibromyalgia to also receive a co-occurring psychiatric diagnosis.

Fibromyalgia has no identified cause. There are a number of varied risk factors that are associated with the development of fibromyalgia, and many of these risk factors are associated with the development of a mental health disorder, such as stress, a history of abuse, first-degree relatives with chronic pain, etc.

Based on information from the book Fibromyalgia: The Complete Guide from Medical Experts and Patients as well as information provided by the Centers for Disease Control and Prevention (CDC). the following symptoms are often associated with individuals diagnosed with fibromyalgia:

  • Chronic pain throughout the body
  • Muscle spasms and stiffness
  • Fatigue
  • Insomnia
  • Super sensitivity to touch, especially at trigger points
  • Tingling or numbness in the hands and feet
  • Issues with body temperature regulation (Patients often either feel too hot or too cold and struggle to maintain a comfortable body temperature.)
  • Issues with headache and tinnitus (chronic ringing in the ears)
  • Reduced activity and an inability to engage in regular exercise
  • Irritable bowel syndrome symptoms
  • Restless leg syndrome
  • Chronic issues with anxiety
  • Chronic issues with depression
  • Issues with attention (especially with maintaining attention or shifting attention), learning and memory, cognitive flexibility, and problem-solving (Some sources refer to the cognitive issues as “fibro fog,” although no specific cognitive syndrome associated with fibromyalgia has ever been identified. The symptoms appear to be quite variable and are often diffuse.)
  • A variable presentation that can sometimes be puzzling (Individuals may have significant periods of time when they exhibit no symptoms and then periods of time when the symptoms are extremely acute and disabling.)

The worldwide prevalence of fibromyalgia is estimated to be 2-5 percent. Females are diagnosed with fibromyalgia at a ratio of 7:1 to males.

There is no cure for fibromyalgia, and treatment is basically provided through three separate modalities that are often combined in an overall treatment plan. According to the CDC and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the three modalities are use of medications, use of physical therapy and exercise, and use of psychotherapy, such as Cognitive Behavioral Therapy (CBT).

  • Medications: A number of medications are used to treat individuals with fibromyalgia. These typically include:
    • Nonsteroidal anti-inflammatory drugs to deal with pain
    • In some cases, prescription opiate drugs like tramadol to address issues with pain and stiffness
    • Antidepressant medications for the treatment of pain, which may include tricyclic antidepressants like Elavil; selective serotonin reuptake inhibitors like Prozac; and some of the newer atypical antidepressant medications, such as Cymbalta or Effexor, that work by inhibiting the reuptake of serotonin and norepinephrine
    • Muscle relaxants, such as Zanaflex, for spasms and pain reduction
    • Anticonvulsant medications like Lyrica
  • Physical activity/therapy: While often not the favored treatment of fibromyalgia patients, physical therapy and exercise can help to reduce pain, increase flexibility, improve mood, and aid individuals in becoming more functional. Exercise programs for patients with fibromyalgia should be regular, light yet invigorating, and involve stretching and numerous movements. For many individuals, finding an activity they enjoy doing has significantly more beneficial effects than trying to get individuals to engage in routine calisthenics, weight training, etc. Thus, walking programs, yoga, dance, pool exercises, and similar exercise programs are often preferred to aerobic programs and weight training.
  • Psychotherapy: CBT is typically the therapy of choice for fibromyalgia. CBT to treat fibromyalgia concentrates on stress reduction, mood improvement, progressive relaxation, and helping individuals become more functional by increasing their motivation and helping them approach the world in a more rational manner.

Numerous adjunctive therapies may be used, including acupuncture, electrical nerve stimulation, ultrasound therapy, music therapy, art therapy, etc.

Alcohol Use and Fibromyalgia

It is well known that alcohol use has a number of potential detrimental effects to physical and mental wellbeing; however, in small to moderate amounts, alcohol use may have some beneficial effects for some individuals. There are several research studies that have investigated the connection between chronic pain and alcohol use. Many of these studies have concentrated on severe forms of arthritis, such as rheumatoid arthritis; however, there are studies that have looked at the prevalence of alcohol use and potential side effects of alcohol use in individuals with fibromyalgia.

A recent study published in the journal Arthritis Research and Therapy looked at the association between complaints of pain in individuals with fibromyalgia and their consumption of alcohol. Over 500 participants were involved in the study. The participants were classified according to their alcohol consumption, such that they were categorized into four groups:

  • No alcohol consumption: 58 percent of the sample
  • Low alcohol consumption (three or less alcoholic drinks per week): 36 percent of the sample)
  • Moderate alcohol consumption (between three and seven alcoholic drinks per week): 3 percent of the sample
  • Heavy alcohol consumption (more than seven alcoholic drinks per week): 3 percent of the sample
Using several varied measures of the functioning of participants, the researchers found that the low to moderate alcohol consumption groups reported having a better quality of life and lower overall pain scores than the heavy drinkers and the nondrinkers. The researchers hypothesized that perhaps the effects of low to moderate alcohol use on the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) may have some therapeutic effects for these patients. However, due to the extremely imbalanced number of participants in each of the groups and failing to control for other important effects, such as the association between very low and moderate alcohol use and being more socially active, this finding was somewhat suspect.  

The researchers were careful to make no claims regarding the use of alcohol causing any of the participants to have less discomfort or to score higher on measures used in the study. They specifically pointed out that the study did not indicate that there was a cause-and-effect relationship between alcohol use and less discomfort in fibromyalgia patients.

A 2015 study published in the same journal with an entirely different sample reported similar findings. Over 13,000 participants were included in the study. The participants in the study were primarily female (57 percent), and the mean age of the participants was relatively high at 55 years old. The rates of alcohol consumption were balanced relatively equally compared to the previous study, with 28 percent of the sample reporting never regularly consuming alcohol, 20 percent reporting low alcohol use, 20 percent reporting moderate alcohol use, and 24 percent reporting heavy alcohol use (based on the parameters of the study that used different qualitative measures than the study mentioned above as this study was performed in the United Kingdom). All the individuals had chronic widespread pain due to a number of different conditions, including fibromyalgia. Individuals reporting moderate alcohol use also reported decreased issues with disability due to their pain. The researchers again cautioned that the relationship should not be considered to be a causal one and, again, that a number of intervening variables could explain this relationship.

In addition, both of the aforementioned studies cite research that indicates that individuals who have chronic pain as a result of other conditions, such as rheumatoid arthritis, often report similar findings of lower pain and disability with mild/moderate alcohol use. However, it should be noted that the general reaction to these studies from healthcare professionals is to caution that heavy alcohol use is known to exacerbate pain and that it would be wrong to think that this research is suggesting that individuals who suffer from chronic pain of any type should begin drinking alcohol in an attempt to deal with their discomfort. Moreover, the development of an alcohol use disorder along with a co-occurring chronic pain condition is far more likely to result in issues with clinical depression and other mental health problems than dealing with either chronic pain or alcohol abuse alone, according to the American Psychiatric Association (APA).

Thus, the findings indicate only that there is some evidence that individuals with conditions, such as fibromyalgia or other forms of chronic pain, who already use alcohol in low to moderate amounts report less dysfunction and a better quality of life than individuals who not drink at all or who drink extremely heavily (this would include having a substance use disorder). The research does not suggest that moderate use of alcohol can be therapeutic for chronic pain, and the other health effects associated with chronic alcohol use would rule out any formal prescription of alcohol as a treatment for fibromyalgia or any other form of chronic pain disorder.

There are numerous anecdotal reports that suggest that some individuals who are diagnosed with fibromyalgia or chronic fatigue syndrome claim they have suffered alcohol intolerance as a result of these conditions. These individuals report that their tolerance for alcohol has decreased once they were diagnosed with these conditions. There does not appear to be any reliable empirical evidence to confirm that this situation exists, and it may most likely reflect many of the emotional and psychological issues that are associated with pain, fatigue, and disability, or an interaction between medications for pain control and alcohol.

Finally, although this research is not well represented, it does not appear that the development of an alcohol use disorder following a diagnosis of fibromyalgia is a significant concern. There does not appear to be a significant body of research that indicates that individuals diagnosed with fibromyalgia go on to develop alcohol use disorders at significant rates as a result of their pain. Individuals diagnosed with fibromyalgia are probably more likely to develop issues with abuse of opiates and other prescription medications as opposed to alcohol abuse issues.

Conclusions

Current research suggests that there may be an association with mild to moderate alcohol use and decreased disability and levels of pain in patients who suffer from fibromyalgia. The research is not causal, such that researchers are not claiming that drinking alcohol causes individuals with fibromyalgia to function better or to have less pain, and this association is probably affected by a number of intervening variables.

It is not recommended that individuals who are diagnosed with fibromyalgia begin drinking alcohol as an attempt to cope with the pain and discomfort of their disorder. However, individuals who are diagnosed with fibromyalgia and continue to engage in their regular activities, including the social use of alcohol, may be at less risk to suffer significant disability and issues with pain and discomfort. Conversely, these individuals may already have significantly less discomfort or are better adjusted to deal with these issues.

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