Analgesic effects of alcohol in adults with chronic jaw pain

Intersection of alcohol use, pain symptoms, and negative affect in total knee arthroplasty patients and people with HIV

Alcohol is a well-known analgesic, although excessive alcohol use can lead to hyperalgesia and heightened negative affect. This cross-sectional study examined associations between alcohol use, self-reported pain, and negative affective symptoms in two distinct cohorts of patients vulnerable to chronic pain: individuals undergoing total knee arthroplasty (TKA) surgery and a cohort of people with HIV (PWH). Participants were enrolled in two clinical studies: a retrospective study of patients undergoing TKA and a longitudinal study of PWH, the New Orleans Alcohol Use in HIV (NOAH) cohort. Based on the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) score, participants in both cohorts were stratified as alcohol drinkers (AUDIT-C ≥ 1) or non-drinkers (AUDIT-C < 1). In the NOAH cohort, pain intensity and interference were assessed using the 36-Item Short Form Survey (SF-36). In the TKA cohort, self-reported pain was quantified using the Pain Intensity and Pain Interference items from the Patient-Reported Outcomes Measurement Information System® (PROMIS-29) and the Knee Osteoarthritis and Outcomes Score (KOOS) Pain scores. Alcohol drinkers reported fewer pain symptoms compared to non-drinkers across both cohorts, and females with HIV reported more pain compared to males with HIV. Furthermore, pain symptoms were associated with increased anxiety and depression symptoms in both cohorts, and in PWH these associations appeared stronger in drinkers compared to non-drinkers. These findings suggest that although alcohol may offer some analgesic benefits, patients should be cautioned about its use for self-medication, as it may increase risk for pain-related negative affective comorbidities. PERSPECTIVE: Alcohol can both relieve and exacerbate pain. The current study discovered that ongoing alcohol use was associated with fewer self-reported pain symptoms but appeared to increase associations between pain and negative affective symptoms in two vulnerable cohorts. Findings support cautioning patients against the recurring use of alcohol for pain management.

Dose-dependent effects of alcohol consumption on pressure pain threshold

INTRODUCTION

Prior laboratory-based studies have identified significant analgesic effects of acute alcohol. Despite providing excellent experimental control, these studies are limited regarding the range of alcohol exposure that can be practically and ethically achieved. This study capitalized on the heterogeneity in breath alcohol concentration (BrAC) resulting from naturalistic alcohol use at a public event to improve understanding of alcohol analgesia. We hypothesized that BrAC would be significantly and positively associated with pain threshold.

METHODS

Participants were attendees of the 2024 Minnesota State Fair reporting alcohol use within the last month (N = 149, 55 % women). Each completed a brief assessment of pressure pain threshold at the first dorsal interosseus muscle. BrAC was measured using a standard breathalyzer device. Hierarchical multiple regression analysis characterized BrAC as a predictor of pain threshold, controlling for covariates including clinical pain, age, sex, typical drinking, participant/experimenter gender matching, and expectancies of alcohol analgesia.

RESULTS

30.9 % of participants had non-zero BrACs, with an average of 0.038 g/dL. Average pain threshold was 3.58 kgf/cm2. Higher BrAC predicted greater pain threshold in both the whole sample (b = 0.145, p = 0.001, η2p = 0.07) and those participants with non-zero BrACs (b = 0.184, p = 0.009, η2p = 0.18). Men had significant greater pain thresholds than women (p = 0.007, η2p = 0.052), but no other covariates reached significance. Addition of quadratic and cubic BrAC terms did not improve model fit.

DISCUSSION

Results suggest a significant, dose-dependent association of alcohol use with increased pain threshold, independent of age, sex, number of reported pain conditions, participant/experimenter gender matching, or beliefs regarding alcohol analgesia. The acute analgesic effects of alcohol may scale linearly with amount consumed, at least within the BrAC range observed in the study.

Alcohol Consumption Modulates the Development of Chronic Pain in COVID-19 Patients: A Network Meta-Analysis

The mechanisms underlying the onset and progression of chronic pain in COVID-19 patients have been understudied. Using network meta-analysis, we previously demonstrated that alcohol augments COVID-19 symptoms and pathologies possibly by inducing a severe cytokine storm. We and others have also reported that acute alcohol consumption produces analgesic effects, while chronic alcohol consumption results in hyperalgesia and chronic pain. This study aimed to identify the influence of alcohol consumption and COVID-19 on pain. Using publicly available curated gene expression data sets of differentially expressed genes (DEGs) in the prefrontal cortex (PFC) and amygdala of COVID-19 patients, we employed a bioinformatics application, QIAGEN ingenuity pathway analysis (IPA), to identify the key signaling pathways, upstream regulators, and biological functions in these brain areas known to play a role in pain. Canonical pathway analysis revealed activation of the neuropathic pain pathway and signaling pathways involving the cytokine storm, S100 family, IL-6, and neuroinflammation. IPA's network builder was employed to construct a network map of shared molecules between alcohol and pain-related constructs (discomfort, neuropathic pain, and inflammatory pain). The simulation of alcohol consumption inhibited pain in this network map. To study the influence of COVID-19, we overlaid the DEGs from the PFC and amygdala onto these networks, mimicking alcohol consumption during SARS-CoV-2 infection. Upregulation of molecules in the amygdala and PFC predicted an increase in neuropathic pain, as well as an increase in inflammatory pain in the PFC. Our results suggest that while alcohol consumption directly inhibits pain, the presence of COVID-19 exaggerates impaired cytokine signaling, neuroinflammation, and neuropathic pain signaling in the CNS providing novel insights into the signaling pathways associated with chronic pain of the COVID-19 patients.

Use and co-use of alcohol and cannabis following physical pain in the daily life of community adults engaged in regular substance use

OBJECTIVE

Alcohol and cannabis are often perceived as pain-relieving. However, minimal work has examined whether people use and co-use these substances following pain in daily life.

METHOD

Forty-six adults reporting weekly use of alcohol and/or cannabis completed a 60-day ecological momentary assessment protocol, answering at least four daily reports on their alcohol and cannabis use and pain (nassessments = 10,769 over 2,656 days). We examined whether self-reported pain so far that day (cumulative-average pain) was associated with subsequent alcohol and cannabis use and same-occasion co-use. Models also addressed whether associations differed for initiating versus continuing a use episode. Hypotheses were preregistered.

RESULTS

A multinomial multilevel model found that cumulative-average pain was associated with a greater likelihood of same-occasion co-use in the continuation phase but not the initiation phase, compared to no use (OR = 1.48,95% CI [1.06, 2.06], p = .023) and alcohol use (OR = 1.52, CI [1.03, 2.26], p = .037). Cumulative-average pain was largely not associated with alcohol-only and cannabis-only use. After alcohol use, greater pain was associated with cannabis use (OR = 1.37, CI [1.11, 1.70], p = .004), but not the reverse. Secondary analyses found greater previous-occasion (not cumulative) pain was associated with initiation of alcohol use and number of drinks, and initiation and continuation of cannabis use, but not number of cannabis hits.

CONCLUSIONS

Although not all hypotheses were supported, pain was associated with subsequent substance use in this sample engaged in regular substance use and not recruited for chronic pain. Cumulative pain may be particularly related to alcohol-cannabis same-occasion co-use, which may increase the risk of substance use-related problems over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Determinants of perceived pain relief from acute alcohol intake in a laboratory setting

Background

Studies of alcohol analgesia often assume that changes in pain sensitivity reflect the negative reinforcing effects of alcohol in pain self-management. However, factors that may influence perceived pain relief due to alcohol use remain incompletely characterized. Thus, the primary aim of this study was to identify which factors are most strongly related to self-reported pain relief in individuals with and without chronic pain after alcohol consumption.

Methods

This study combined data from two studies of alcohol analgesia in individuals who regularly consume alcohol with and without chronic pain. Alcohol analgesia expectancies were assessed during screening. In laboratory sessions, participants received an alcohol-containing (.08 g/dL target BrAC) or placebo beverage and rated subjective intoxication and subjective response (positive/negative aspects of stimulation/sedation). Participants underwent quantitative sensory testing to measure pain intensity, pain threshold, and relief. Paired sample t-tests determined effects of alcohol on pain measures. Hierarchical linear models determined factors associated with pain relief ratings in the alcohol condition.

Results

Pain relief and pain threshold were higher in the alcohol session relative to placebo, but pain intensity did not differ. In a 4-step hierarchical linear model, expectancy of pain relief, subjective intoxication, and high positive affect, but not pain threshold or pain intensity, were significantly and uniquely associated with perceived relief.

Conclusions

Taken together, results suggest the negative-reinforcing effects of alcohol for pain-management are not completely reflected by changes in pain sensitivity in a laboratory setting. Expectancies and subjective response may be important in determining an individual's evaluation of alcohol's efficacy for pain self-management.

Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic

Alcohol use disorder (AUD) and chronic pain disorders are pervasive, multifaceted medical conditions that often co-occur. However, their comorbidity is often overlooked, despite its prevalence and clinical relevance. Individuals with AUD are more likely to experience chronic pain than the general population. Conversely, individuals with chronic pain commonly alleviate their pain with alcohol, which may escalate into AUD. This narrative review discusses the intricate relationship between AUD and chronic pain. Based on the literature available, the authors present a theoretical model explaining the reciprocal relationship between AUD and chronic pain across alcohol intoxication and withdrawal. They propose that the use of alcohol for analgesia rapidly gives way to acute tolerance, triggering the need for higher levels of alcohol consumption. Attempts at abstinence lead to alcohol withdrawal syndrome and hyperalgesia, increasing the risk of relapse. Chronic neurobiological changes lead to preoccupation with pain and cravings for alcohol, further entrenching both conditions. To stimulate research in this area, the authors review methodologies to improve the assessment of pain in AUD studies, including self-report and psychophysical methods. Further, they discuss pharmacotherapies and psychotherapies that may target both conditions, potentially improving both AUD and chronic pain outcomes simultaneously. Finally, the authors emphasize the need to manage both conditions concurrently, and encourage both the scientific community and clinicians to ensure that these intertwined conditions are not overlooked given their clinical significance.

Expectancy of alcohol analgesia moderates perception of pain relief following acute alcohol intake

Although laboratory studies indicate alcohol reduces pain intensity and increases pain threshold, these effects likely do not completely explain perceived pain relief from alcohol intake. In this study, we tested expectancy of alcohol analgesia (EAA) as a moderator of subjective pain relief following oral alcohol challenge in individuals with and without chronic orofacial pain. Social drinkers (N = 48; 19 chronic pain; 29 pain-free controls) completed two testing sessions: alcohol administration (BrAC: 0.08 g/dL) and placebo. Alcohol expectancy (AE) was assessed using the EAA questionnaire and two 100-mm Visual Analogue Scales (VASs) regarding strength of belief that alcohol provides pain relief (AE VAS 1) or reduces pain sensitivity (AE VAS 2). Participants completed quantitative sensory testing (QST) involving application of pressure to the masseter insertion. Pain threshold (lbf; three repetitions) and pain intensity (4, 5, and 6 lbf; three repetitions each; 100-mm VAS) were collected. After each stimulus, participants rated perceived pain relief due to consumption of the study beverage (0-100 VAS). Higher EAA and AE VAS 1 ratings were associated with stronger perceived relief in the alcohol, but not placebo, condition. However, expectancy specifically related to reduction in pain sensitivity (AE VAS 2) was not associated with relief. Additionally, changes in pain threshold and intensity were not significantly correlated with perceived relief. Taken together, results suggest expectancy that alcohol provides pain relief is an important determinant of its negative reinforcing effects. Future studies should investigate challenging these expectancies as a means of reducing alcohol-related risk in people with pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain and Hazardous Alcohol Use in Veterans in Primary Care: The Role of Affective Pain Interference and Alcohol Pain-Coping Perceptions

Chronic pain and unhealthy alcohol use commonly co-occur and are associated with negative health outcomes. Veterans may be particularly vulnerable to these conditions, yet limited research has examined factors involved in their co-occurrence. This cross-sectional study aimed to examine the role of affective pain interference and alcohol pain-coping perceptions in the relationship between pain and hazardous alcohol use. As informed by the catastrophizing, anxiety, negative urgency, and expectancy model, we hypothesized that the relationship between pain and hazardous alcohol consumption is mediated by affective pain interference and stronger among those with greater perceptions that alcohol helps cope with pain. Participants were 254 VA primary care patients (87.8% male, Mage = 64.03, 76.4% White) with a history of chronic musculoskeletal pain, past-year alcohol use, and past-week pain. Veterans completed a mailed survey including measures of pain, affective pain interference, alcohol pain-coping perceptions, and hazardous alcohol use. Hypotheses were tested with regression models and PROCESS macros. As hypothesized, affective pain interference mediated the pain-hazardous alcohol use association. Contrary to hypotheses, results showed no moderating effect of alcohol pain-coping perceptions. Findings partially support relationships among theorized constructs and suggest that for Veterans with co-occurring pain and alcohol use it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain. PERSPECTIVE: This article presents a test of factors involved in the pain and alcohol relationship, as informed by the CANUE model. Findings suggest that for Veterans with co-occurring pain and past-year alcohol use, it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain.

Alcohol use and the pain system

The World Health Organization's epidemiological data from 2016 revealed that while 57% of the global population aged 15 years or older had abstained from drinking alcohol in the previous year, more than half of the population in the Americas, Europe, and Western Pacific consumed alcohol. The spectrum of alcohol use behavior is broad: low-risk use (sensible and in moderation), at-risk use (e.g., binge drinking), harmful use (misuse) and dependence (alcoholism; addiction; alcohol use disorder). The at-risk use and misuse of alcohol is associated with the transition to dependence, as well as many damaging health outcomes and preventable causes of premature death. Recent conceptualizations of alcohol dependence posit that the subjective experience of pain may be a significant contributing factor in the transition across the spectrum of alcohol use behavior. This narrative review summarizes the effects of alcohol at all levels of the pain system. The pain system includes nociceptors as sensory indicators of potentially dangerous stimuli and tissue damage (nociception), spinal circuits mediating defensive reflexes, and most importantly, the supraspinal circuits mediating nocifensive behaviors and the perception of pain. Although the functional importance of pain is to protect from injury and further or future damage, chronic pain may emerge despite the recovery from, and absence of, biological damage (i.e., in the absence of nociception). Like other biological perceptual systems, pain is a construction contingent on sensory information and a history of individual experiences (i.e., learning and memory). Neuroadaptations and brain plasticity underlying learning and memory and other basic physiological functions can also result in pathological conditions such as chronic pain and addiction. Moreover, the negative affective/emotional aspect of pain perception provides embodied and motivational components that may play a substantial role in the transition from alcohol use to dependence.

Neural and Psychosocial Mechanisms Underlying Alcohol Use and Pain Interactions: Overview of Current Evidence and Future Directions

Purpose of Review

A growing body of research indicates bidirectional associations between alcohol use and pain. In this review, we highlight common neural and psychosocial mechanisms underlying pain and alcohol use and identify current gaps in the literature regarding alcohol/pain interactions. We also suggest future directions for the field moving forward, including more nuanced conceptualization of alcohol's negative reinforcing effects in the context of pain, broader use of clinically-relevant experimental pain induction modalities, and characterization of age, biological sex, gender, race, and ethnicity as moderators of pain/alcohol interactions.

Recent Findings

Acute alcohol intake has analgesic and negative-reinforcing effects in the context of pain, and chronic heavy alcohol use appears to increase risk for development of chronic pain. At the same time, pain, both acute and chronic, acts as a proximal antecedent for alcohol use and is associated with relapse risk for individuals in recovery from alcohol use disorder.

Summary

Although the links between alcohol use and pain are increasingly appreciated, significant gaps in understanding remain and systematic study of alcohol/pain interactions at all levels, including basic, preclinical, translational, and interventional, is needed.

Mechanical and Heat Hyperalgesia upon Withdrawal From Chronic Intermittent Ethanol Vapor Depends on Sex, Exposure Duration, and Blood Alcohol Concentration in Mice

Approximately half of patients with alcohol use disorder report pain and this can be severe during withdrawal. Many questions remain regarding the importance of biological sex, alcohol exposure paradigm, and stimulus modality to the severity of alcohol withdrawal-induced hyperalgesia. To examine the impact of sex and blood alcohol concentration on the time course of the development of mechanical and heat hyperalgesia, we characterized a mouse model of chronic alcohol withdrawal-induced pain in the presence or absence the alcohol dehydrogenase inhibitor, pyrazole. Male and female C57BL/6J mice underwent chronic intermittent ethanol vapor ± pyrazole exposure for 4 weeks, 4 d/wk to induce ethanol dependence. Hind paw sensitivity to the plantar application of mechanical (von Frey filaments) and radiant heat stimuli were measured during weekly observations at 1, 3, 5, 7, 24, and 48 hours after cessation of ethanol exposure. In the presence of pyrazole, males developed mechanical hyperalgesia after the first week of chronic intermittent ethanol vapor exposure, peaking at 48 hours after cessation of ethanol. By contrast, females did not develop mechanical hyperalgesia until the fourth week; this also required pyrazole and did not peak until 48 hours. Heat hyperalgesia was consistently observed only in females exposed to ethanol and pyrazole; this developed after the first weekly session and peaked at 1 hour. We conclude that Chronic alcohol withdrawal-induced pain develops in a sex-, time-, and blood alcohol concentration-dependent manner in C57BL/6J mice. PERSPECTIVE: Alcohol withdrawal-induced pain is a debilitating condition in individuals with AUD. Our study found mice experience alcohol withdrawal-induced pain in a sex and time course specific manor. These findings will aid in elucidating mechanisms of chronic pain and AUD and will help individuals remain abstinent from alcohol.