Friday, October 2, 2009

Alcohol Misuse for Pain, a Commonplace Hazard

Healthcare providers should be concerned about alcohol misused by their patients to self-manage pain and caution them about the hazards of mixing alcohol with pain medications, according to a study recently published in the Journal of Pain [Riley and King 2009]. One in four patients may abuse alcohol as an analgesic, which appears to be most problematic among young white males and is exacerbated by greater pain frequency and depression.

It is well known that serious adverse reactions may occur when alcohol is mixed with analgesics for self-medication, and alcohol also is often misused to manage the added stress of chronic pain. Researchers from the University of Florida College of Dentistry conducted an extensive telephone-interview study to examine the use of alcohol to relieve pain in more than 4,300 adults with tooth pain (n=1,767), jaw or face pain (n=1,199), or arthritis pain (n=1,355). Results showed that more than a quarter of those interviewed (28%) misused alcohol as a pain management strategy. Such use was more frequent in men than women, in non-Hispanic whites, and among those at higher income levels. Additionally, alcohol use for pain was greatest in younger adults and in those with higher education, greater pain frequency, and/or experiencing depression. Only one factor, being married, seemed somewhat protective against the misuse of alcohol to manage pain.

The authors of this research funded by the U.S. National Institutes of Health recommend that the possible misuse of alcohol for self-managing pain should be assessed during treatment evaluation. Physicians and other health care providers need to be aware of their patients’ concomitant use of alcohol and pain medication, assess patients for psychosocial impairment due to alcohol, and when appropriate make adjustments to treatment or referrals to outside support services.

Comment: This study did not assess what proportion of those interviewed had pre-existing problems with alcohol use. As we have previously noted [see blogpost 9/16/09], 15.2 million Americans abuse or are addicted to alcohol, plus 3.1 million have abuse or addiction involving both alcohol and illicit drugs, according to U.S. government survey data. These figures, combined with the 58 million persons who are binge drinkers and 17.3 million reporting heavy drinking (according to the data), amounts to about 94 million persons with alcohol-use problems. This, alone, presents a very large population at high risk for adverse reactions, including potential overdose and death, when treated with prescription or OTC analgesics. Still unknown is the number of social drinkers who increase their alcohol use to cope with the discomfort and stress of pain, thereby risking adverse consequences when alcohol is combined with analgesic drugs.

Reference: Riley III JL, King C. Self-report of alcohol use for pain in a multi-ethnic community sample. J Pain. 2009(Sep);10(9):944-952 [see abstract].