Pain, alcohol use disorders and risky patterns of drinking among people with chronic non-cancer pain receiving long-term opioid therapy
The prescribing and use of pharmaceutical opioids has increased internationally. The authors reviewed data from the Pain and Opioids IN Treatment (POINT) cohort of 1514 people in Australia prescribed pharmaceutical opioids for CNCP to examine the patterns and correlates of risky drinking in the cohort, and to investigate the associations between alcohol consumption and pain.
Less than one-tenth of the sample were ‘lifetime abstainers’ (7%); 34% were ‘former drinkers’; 34% were ‘non-risky drinkers’ (i.e., past 12 month use ≤4 standard drinks); 16% were ‘occasional risky drinkers’; and 8% were ‘regular risky drinkers’ (i.e., ≥weekly use of >4 standard drinks). Males reported greater levels of alcohol use, and a third (33%) of the total sample reported a lifetime alcohol use disorder.
The study was uniquely placed to shed light on the relationship between pain and alcohol use in a large cohort of people with CNCP prescribed strong opioids, while taking into consideration a wide array of demographic characteristics, mental and physical health, and substance use behaviours. The investigators found that ‘former drinkers’ typically displayed poorer clinical profiles when compared with ‘non-risky drinkers’, including higher levels of anxiety and lifetime AUDs, poorer quality of life, poorer physical health scores, higher pain severity and interference ratings and lower levels of pain coping. This group were typically older, with multiple pain conditions.
‘Former drinkers’ were more likely than ‘non-risky drinkers’ to report higher pain severity and interference ratings, and lower pain coping after controlling for demographics, mental health, physical health and substance use disorder history.
At the other end of the spectrum, ‘occasional risky drinkers’ and ‘regular risky drinkers’ reported more social disadvantage and poorer physical health and substance use profiles (including life-time AUDs) than ‘non-risky drinkers’. These groups were typically younger, with fewer pain conditions, but reported higher pain severity and interference ratings. ‘Occasional risky drinkers’ and ‘regular risky drinkers’ reported higher levels of pain interference than ‘non-risky drinkers’ after controlling for confounders.
The authors stress that the data are correlational and cannot be taken as showing that moderate alcohol consumption improves pain outcomes. Rather, quitting drinking was associated with poorer physical health, and risky alcohol consumption was associated with higher levels of social disadvantage, compared to moderate drinking.
What does it mean and what can be done?
Chronic pain and alcohol use are highly prevalent in the general population and are major clinical and public health issues. This study finds clear associations between alcohol use and pain severity and interference. Compared with moderate alcohol consumption, having ceased alcohol use or engaging in risky drinking are each associated with poorer pain outcomes. Risky-drinking may be a modifiable factor that, if addressed, might positively impact on pain outcomes. In the context of an increasing, ageing population of people with CNCP and comorbid physical and mental health problems, The interplay between alcohol use, pain and quality of life is likely to remain a critical area for further work. The comorbidity of CNCP, substance use and other mental disorders is manifest as greater disability in daily functioning and greater complexity in treatment, requiring integration of alcohol and drug treatment services and pain services with primary care.