Reflections of rehabilitation professional: alcohol

Alcohol has many aspects to its use. Your trustees have often arranged meetings for new and old members of the VRA to enhance social interaction and mutual support as well as educational meetings, assisted by a drop of alcohol. I had been a consultant for some years before I learned about the easing of pain by use of alcohol [1].

A colleague contacted me to explain that a relative had severe back pain at home and could I go and see him? I visited on a Monday morning and the smell of alcohol was clear and the ‘patient’ explained that having a drink had eased his back pain but that now he was drinking too much! I arranged appropriate advice and discussed the issue with a colleague from the Medical
Research Council which resulted in our doing a study of alcohol use in those attending my back pain clinic. This suggested that the less one drank the more disabling the back pain appeared to be with 11% of the sample admitting to high alcohol intake [2]. This risk appears greater in men [3] and possibly notable in ex-servicemen [4]. At that time, I had not realised how many of my patients came from a South Asian background nor how many might be teetotal. One must bear in mind however, as a Sikh gentleman told me with a smile, that gentlemen who do not drink at home may well drink elsewhere!

On another occasion, I was sitting in the wheelchair clinic that assessed those with mobility impairments for their eligibility for an electric-powered indoor/outdoor wheelchair which was subject to strict criteria as they were severely rationed at the time [5]. The individual in front of me was smelling of alcohol but informed me that there was a good reason for it. I was taken in, and we prescribed the chair. Some weeks later, reports of children racing down the street in a wheelchair meant that we had to take it back. It may well be true that had I been in a back pain clinic wearing a different ‘hat’ I would have taken the risk of alcohol abuse more seriously, but in any event – I made the mistake of being taken in by an alcohol abuser!

It is timely to review the subject now that Covid-19 exposes us to a new series of risk factors for abnormal behaviour. Many people reacted to the closure of shops and restaurants by stocking up on alcohol to drink at home in isolation [6]. The risks of alcohol may be increased by two mechanisms due to the Covid-19 epidemic. Firstly, those who were struggling with alcohol dependence may have difficulties getting their usual support as they may not have access to find web-based support nor find it as helpful as face-to-face support. Secondly those on the brink of dependency may be tipped over by bereavement, job insecurity or troubled relationships [6]. These factors would be independent of any associated pain, which often follows an injury.

Conclusions

We should be on our guard for clients at risk of abusing alcohol. Chronic pain may well increase the risk of alcohol abuse which our clients may be disguising very effectively.

I am happy to discuss any of the issues raised in these reflections with colleagues who can email me at andrew.frank1 at btinternet.com and head the email VRA – professional reflections.

Andrew Frank

Trustee and Past-Chair, VRA.

PS I have been alerted to several items published after I had written the above, Coronavirus: ‘I became alcoholic during lockdown’ here and the newly published CIPD guidance for managing drug and alcohol misuse at work here.

Reference

  1. Robins, M.T., M.M. Heinricher, and A.E. Ryabinin, From Pleasure to Pain, and Back Again: The Intricate Relationship between Alcohol and Nociception. Alcohol and Alcoholism, 2019. 54(6): p. 625-638.
  2. Gorman, D., et al., Relationship between alcohol abuse and low back pain. Alcohol alcohol, 1987. 22(1): p. 61-63.
  3. Booker, E., A. Haig, and M.Y. Geisser, K., Alcohol use self-report in chronic back pain – relationships to psychosocial factors, function performance, and medication use. Disabil Rehabil, 2003. 25(22): p. 1271-1277.
  4. Bryan, C.J., et al., Associations Among Back and Extremity Pain With Alcohol, Tobacco, and Caffeine Use Among US Air Force Pararescuemen. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015. 15(3): p. 66-71.
  5. Frank, A., et al., Introduction of the new NHS Electric Powered Indoor/outdoor Chair (EPIOC) service: benefits, risks and implications for prescribers. Clin Rehabil, 2000. 14(December): p. 665-673.
  6. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.
  7. Robins, M.T., M.M. Heinricher, and A.E. Ryabinin, From Pleasure to Pain, and Back Again: The Intricate Relationship between Alcohol and Nociception. Alcohol and Alcoholism, 2019. 54(6): p. 625-638.
  8. Gorman, D., et al., Relationship between alcohol abuse and low back pain. Alcohol alcohol, 1987. 22(1): p. 61-63.
  9. Booker, E., A. Haig, and M.Y. Geisser, K., Alcohol use self-report in chronic back pain – relationships to psychosocial factors, function performance, and medication use. Disabil Rehabil, 2003. 25(22): p. 1271-1277.
  10. Bryan, C.J., et al., Associations Among Back and Extremity Pain With Alcohol, Tobacco, and Caffeine Use Among US Air Force Pararescuemen. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2015. 15(3): p. 66-71.
  11. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.
  12. Robins, M.T., M.M. Heinricher, and A.E. Ryabinin, From Pleasure to Pain, and Back Again: The Intricate Relationship between Alcohol and Nociception. Alcohol and Alcoholism, 2019. 54(6): p. 625-638.
  13. Gorman, D., et al., Relationship between alcohol abuse and low back pain. Alcohol alcohol, 1987. 22(1): p. 61-63.
  14. Booker, E., A. Haig, and M.Y. Geisser, K., Alcohol use self-report in chronic back pain – relationships to psychosocial factors, function performance, and medication use. Disabil Rehabil, 2003. 25(22): p. 1271-1277.
  15. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.
  16. Robins, M.T., M.M. Heinricher, and A.E. Ryabinin, From Pleasure to Pain, and Back Again: The Intricate Relationship between Alcohol and Nociception. Alcohol and Alcoholism, 2019. 54(6): p. 625-638.
  17. Gorman, D., et al., Relationship between alcohol abuse and low back pain. Alcohol alcohol, 1987. 22(1): p. 61-63.
  18. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.
  19. Robins, M.T., M.M. Heinricher, and A.E. Ryabinin, From Pleasure to Pain, and Back Again: The Intricate Relationship between Alcohol and Nociception. Alcohol and Alcoholism, 2019. 54(6): p. 625-638.
  20. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.
  21. Finlay, I. and I. Gilmore, Covid-19 and alcohol-a dangerous cocktail. BMJ (Clinical research ed.), 2020. 369: p. m1987.