Pain in alcohol use disorder: Evaluating effects of childhood trauma, perceived stress, and psychological comorbidity

• Published in: Alcohol (Fayetteville, N.Y.) N.Y.), 2024-06, Vol.117, p.43-54
• Main Authors: Schwandt, M.L., Ramchandani, V.A., Upadhyay, J., Ramsden, C., Diazgranados, N., Goldman, D.
• Format: Article
• Language: English
• Subjects: Adult; Adverse childhood experiences; Adverse Childhood Experiences - psychology; Alcohol abuse; Alcohol use; Alcohol Use Disorder; Alcoholism - epidemiology; Alcoholism - psychology; Analgesics; Anxiety; Childhood; Childhood Abuse; Children; Chronic Pain; Comorbidity; Drinking behavior; Drug abuse; Drug withdrawal; Female; Humans; Male; Mental disorders; Mental health; Middle Aged; Narcotics; Pain; Pain - epidemiology; Pain - psychology; Post traumatic stress disorder; PTSD; Public health; Risk Factors; Sociodemographics; Socioeconomic factors; Stress; Stress, Psychological - epidemiology; Stress, Psychological - psychology; Trauma; Withdrawal
• ISSN: 0741-8329; 1873-6823; 1873-6823
• DOI: 10.1016/j.alcohol.2024.03.013

The relationship between pain and alcohol use disorder (AUD) is complex and bidirectional. The current study examines risk factors for pain in a large comprehensively phenotyped sample including individuals from across the spectrum of alcohol use and misuse. Participants (n = 1101) were drawn from the National Institute on Alcohol Abuse and Alcoholism Natural History Protocol and included treatment-seeking AUD inpatients (AUD+Tx, n = 369), individuals with AUD not seeking treatment (AUD+, n = 161), and individuals without AUD (AUD-, n = 571). General linear models were utilized to test the effects of AUD status, history of childhood trauma exposure, perceived stress, and psychological comorbidity on daily percent time in pain, as well as change in daily percent time in pain across the inpatient stay in AUD+Tx individuals. Overall, 60.2% individuals reported any pain, with a significantly higher prevalence in the AUD+Tx group (82.1%) compared to the AUD+ (56.5%) and AUD- (47.1%) groups. Daily percent time in pain was also highest in the AUD+Tx group (30.2%) and was further increased in those with a history of childhood abuse and comorbid posttraumatic stress disorder (PTSD). Years of heavy drinking and craving were also associated with increased percent time in pain in the AUD+Tx group. Percent time in pain decreased following acute withdrawal in the AUD+Tx group but plateaued around 25% just prior to discharge. Individuals seeking inpatient treatment for AUD, especially those with a history of childhood trauma and/or comorbid PTSD, report greater percent time in pain compared to those not seeking treatment and those without AUD. The prolonged experience of pain in abstinent AUD inpatients after the resolution of acute withdrawal may signal the early stages of protracted withdrawal. Integrative treatments targeting pain and other symptoms of protracted withdrawal may be effective in improving overall function in people with severe AUD. •Pain was highly prevalent in individuals seeking treatment for alcohol use disorder (AUD).•Individuals seeking treatment for AUD reported greater pain than individuals not seeking treatment.•Childhood abuse and PTSD comorbidity was associated with increased pain in treatment-seeking AUD inpatients.•Both craving and years of heavy drinking were associated with pain in AUD inpatients.•Greater than 60% of AUD inpatients were still experiencing pain just prior to discharge.