Pain Severity May Be Associated With Opioid Misuse in Chronic Pain With High Alcohol Use

In individuals with chronic pain and higher, but not lower alcohol use, pain severity may be associated with opioid misuse.

In individuals with chronic pain and higher, but not lower, alcohol use, pain severity may be associated with opioid misuse, according to a study published in Drug and Alcohol Dependence.

Individuals from the United States who had chronic pain were recruited to participate in 2 online surveys. In the first study, patients with chronic pain (n=364) were assessed for pain severity using a 0 to 10 pain scale, self-reported depression symptoms using the 16-item British Columbia major depression inventory, self-reported current opioid misuse with the 17-item current opioid misuse measure (COMM), and alcohol use with the 10-item alcohol use disorders identification test. In study 2, the following measures were assessed in patients with chronic pain (n=437): depression, using the 2-item patient health questionnaire-2; alcohol, smoking, and substance use, using the 8-item alcohol, smoking, and substance involvement screening test alcohol subscale; pain severity with the 3-item graded chronic pain scale; and opioid misuse with the COMM.

An interaction was established in the first study between pain severity and alcohol use (P <.001), and alcohol use was found to represent a predictor of opioid misuse (P <.001). An association between opioid misuse and higher alcohol use was established in study 1 (P <.001), but not between opioid misuse and lower alcohol use (P =.430).

In study 2, an interaction was established between pain severity and alcohol use (P <.001), as well as an association between pain and opioid misuse in participants with higher alcohol use (P <.001), but not in those with lower use of alcohol (P =.620).

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Study limitations include the recruitment of participants based on chronic pain rather than opioid use in study 1, and the lack of data on prescription and nonprescription opioid use and dosage in study 2.

 “[C]linicians should consider regularly screening and providing resources for alcohol use among individual with chronic pain, and perhaps consider lowering the threshold for what may be considered problematic drinking among chronic pain patients, particularly those who may be using opioids,” noted the study authors.

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Paulus DJ, Rogers AH, Bakhshaie J, Vowles KE, Zvolensky MJ. Pain severity and prescription opioid misuse among individuals with chronic pain: The moderating role of alcohol use severity. Drug Alcohol Depend. 2019;204:107456.