Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect.

Abstract

Objective Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of two clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. Method Participants included 1383 individuals from the COMBINE Study (COMBINE Study Group, 2003; 31% female, 23% ethnic minorities, average age=44.4 (SD=10.2)), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age=41.6 (SD=10.1)) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). Results Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. Conclusion Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse.

Pain moderates changes in psychological flexibility but not substance use symptoms during substance use disorder treatment

“…SUD patients with both actue and chronic pain problems report more extensive drug use histories, greater severity of drug and alcohol problems, and more co-morbid psychiatric symptom sequelae than those without significant pain (Jakubczyk et al, 2015; Potter et al, 2008; Witkiewitz et al, 2015a, 2015b). Further, those in pain are less likely to attend or complete SUD treatment and reductions in pain predict lower risk of relapse following treatment (Jakubczyk et al, 2016).…”

“…During treatment sessions, acute pain may co-opt cognitive resources vital for processing information (Attree et al, 2003; Crombez, 1998; Crombez et al, 1998; Dick et al, 2002) and impede the frequency and accuracy of behavioral practice (Crombez et al, 1997; Harman and Ruyak, 2005). Additionally, pain has been shown to amplify hopelessness and negative affect during the early phases of SUD recovery (Bair et al, 2003; Samwel et al, 2006; Witkiewitz et al, 2015a, 2015b). These proximal cognitive, behavioral and emotional effects of pain during treatment may underlie the poor outcomes associated with concurrent pain and SUD.…”

The Association Between Alcohol Consumption and Pain Interference in a Nationally Representative Sample: The Moderating Roles of Gender and Alcohol Use Disorder Symptomatology

“…Further, a second study using NESARC data showed that individuals in abstinent remission reported greater pain interference than those in nonabstinent remission (Dawson et al, ). Together, these studies suggest that complete cessation of drinking might play an important role in elevating pain interference, possibly through the mechanism of withdrawal‐induced hyperalgesia, which later leads to the increased rates of relapse and increased consumption observed in prior studies (e.g., Jakubczyk et al, ; Witkiewitz et al, ). Unfortunately, because of the small number of individuals in the 2 or more symptoms group that transitioned from drinker to abstainer between the NESARC surveys ( N = 198) and the lack of additional time points, we could not evaluate this hypothesis in the present study.…”

“…For instance, Brennan and colleagues () reported more use of alcohol as a pain‐coping strategy among problem drinkers versus nonproblem drinkers. Further, multiple studies have linked pain to higher relapse risk among individuals diagnosed with AUD (Jakubczyk et al, ; Witkiewitz et al, ). Thus, our literature review suggests that pain‐related reductions in drinking may be more commonly observed among pain patients without AUD symptomatology.…”

Relationships between components of emotional intelligence and physical pain in alcohol-dependent patients

“…Our findings should be confirmed within the experimental design of longitudinal observations. Moreover, our single-item, self-report measure of pain intensity in the previous 4 weeks is unidimensional, albeit utilized in other studies 12,76,77. It does not assess for the perceptual threshold, cause, location, or type of pain as well the specific context for its chronicity, origin, or continuation into the present.…”