Intended for healthcare professionals

Clinical Review Recent developments

Management of pain

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:635


This article is a valuable contribution to the subject of pain and
its management, emphasising a mechanism-based approach, new drug
development, and most important, care that is individualised, holistic and
multidisciplinary. It is unfortunate that consideration of drug therapy
appears largely focussed on opioids and makes no mention of mankind's most
venerable analgesic, ethyl alcohol.

There are several good reasons why alcohol, usually by mouth but
occasionally by the intravenous route, should be considered as a component
of the management of severe chronic pain. First, alcohol is a very potent
analgesic, as anyone who has sutured lacerations in an intoxicated patient
can affirm - local anaesthesia is commonly not required. Further, it is
possible to induce substantial analgesia with doses of alcohol that do not
induce an unwanted drunken state. Second, to many patients the central
effects of the narcotic analgesics are unfamiliar and frequently
disturbing, producing not euphoria but dysphoria and depression. As a
result, patients frequently take less aanalgesia than is required for
optimal pain control. By contrast, the effects of alcohol are familiar to
most people and are usually regarded as pleasant, tending to produce
euphoria and banish depression. Third, the ingestion of alcohol promotes
appetite, whereas narcotics frequently induce nausea and anorexia. Fourth,
alcohol is the only analgesic agent that is also a source of calories;
this enhances its value in cancer patients. Fifth, alcohol is readily
combined with narcotics as an adjuvant drug - witness the gin in Brompton
mixture. Finally, whereas many patients have strong preconceived ideas
about the evils of narcotics, profound disapproval of the taking of
alcohol is relatively uncommon, especially when it is recommended for a
medical purpose. This ancient and valuable agent should be considered as a
component of pain management.

Competing interests:  
None declared

Competing interests: No competing interests

26 March 2003
Alexander S.D. Spiers
Retired Professor of MedicineN/A