Pain Symptoms and Return to Drinking During and After Treatment for Alcohol Use Disorder

Research indicates that alcohol use is higher among individuals with chronic pain. In this study, researchers used data from 2 large alcohol use disorder (AUD) treatment trials, COMBINE (N=1383) and UK Alcohol Treatment Trial (UKATT; N=742), to assess whether pain is related to AUD treatment outcomes. For each trial separately, they assessed associations between pain and drinking in time to event analyses adjusted for gender, baseline drinking days, AUD severity, motivation, self-efficacy, temptation, mental health symptoms, and type of AUD treatment. The main results are shown in the table:

Values are hazard ratios (95% confidence interval) that depict change in risk for each unit increase in pain score.

Comments:

This secondary analysis shows an inconsistent association of pain symptoms with alcohol use during and after AUD treatment. Nonetheless, it does appear that pain may be associated with relapse at least under some circumstances, so clinicians should address it. In this population, behavioral therapy, non-opioid medication and, as appropriate, physical therapy are optimal approaches, whether initiated by the AUD treatment team or in concert with primary care providers.

Kevin L. Kraemer, MD, MSc

Reference:

Witkiewitz K, Vowles KE, McCallion E, et al. Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial. Addiction. 2015;110:1262–1271.