A new study published in the journal Alcohol highlights the significant link between chronic pain and alcohol use disorder, with a particular focus on individuals seeking treatment for their condition. The research found that over 80% of people undergoing inpatient treatment for alcohol use disorder reported experiencing frequent pain, a prevalence that was much lower in individuals with alcohol use disorder who were not seeking treatment. Additionally, the study identified key factors—such as childhood abuse—that are associated with higher levels of pain in this population.
Alcohol use disorder affects millions of adults in the United States, with serious public health and economic implications. At the same time, chronic pain is an even more widespread issue, affecting over 50 million Americans. Previous research has shown that chronic pain and problematic alcohol use are closely connected. For example, some people use alcohol to cope with pain, but over time, heavy drinking can worsen pain and lead to more alcohol dependence.
Given the severity and complexity of both alcohol use disorder and chronic pain, researchers wanted to better understand how these two conditions interact, particularly in individuals seeking treatment for alcohol use disorder. These individuals often experience more severe symptoms and complications than those who do not seek treatment, but pain in this group has not been thoroughly studied. The new study aimed to explore the prevalence and severity of pain in different groups of people with alcohol use disorder and identify risk factors that might influence their experience of pain.
The study investigated the relationship between pain and alcohol use disorder by examining a large, diverse sample of individuals across a spectrum of alcohol use. Participants were recruited as part of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Natural History Protocol, which comprehensively evaluates individuals for a wide range of clinical and behavioral characteristics.
This sample included 1,101 participants who were categorized into three groups: individuals with alcohol use disorder receiving inpatient treatment (369 participants), individuals with alcohol use disorder not seeking treatment (161 participants), and individuals without alcohol use disorder (571 participants).
Pain was measured using the Whole Body Pain Scale, a self-report questionnaire that asks individuals to rate the amount of time they experience pain during their waking hours over the past seven days. For the inpatient group, pain assessments were taken at several points during their 30-day stay: on days 2, 8, 16, and 23. This repeated measurement allowed the researchers to track changes in pain during treatment.
Participants also provided information on key risk factors, including their demographic background, history of childhood trauma, current stress levels, and psychiatric comorbidities like post-traumatic stress disorder. Other alcohol-related measures were collected, such as the number of years of heavy drinking and the severity of alcohol cravings.
The findings showed a high prevalence of pain among individuals seeking inpatient treatment for alcohol use disorder. More than 80% of this group reported experiencing pain, and they spent about 30% of their waking hours in pain. In contrast, 56% of individuals with alcohol use disorder not seeking treatment reported pain, and they spent about 15% of their waking hours in pain.
For individuals without alcohol use disorder, 47% reported pain, and they experienced it for just 7.6% of their waking hours. These results suggest that the severity of alcohol use disorder and its associated complications, such as withdrawal, play a role in the high prevalence of pain among treatment-seeking individuals.
Several risk factors were associated with higher levels of pain. One of the strongest predictors was a history of childhood abuse, including emotional, physical, or sexual abuse. Participants who had experienced childhood abuse reported significantly more pain, particularly if they also had a diagnosis of post-traumatic stress disorder.
Other factors linked to increased pain included the number of years participants had engaged in heavy drinking and the intensity of their alcohol cravings. Interestingly, while previous research has often found that women report more pain than men, this study did not find significant gender differences in pain levels across any of the three groups.
While the inpatient group did experience a slight reduction in pain during their stay—especially in the first week as their withdrawal symptoms were managed—pain levels remained high throughout their treatment. Even by the end of the treatment program, more than 60% of individuals still reported daily pain, indicating that pain can persist beyond the acute withdrawal phase into the longer-term recovery process. This was true even for individuals who received pain medications during their treatment.
The study’s results emphasize the complexity of pain in individuals with alcohol use disorder, particularly those seeking treatment. It suggests that long-term alcohol use, childhood trauma, mental health conditions like post-traumatic stress disorder, and alcohol cravings all contribute to a higher pain burden. Despite treatment efforts to manage both alcohol dependence and pain, many individuals continue to experience significant pain, highlighting the need for more effective pain management strategies in this population.
The study, “Pain in alcohol use disorder: Evaluating effects of childhood trauma, perceived stress, and psychological comorbidity,” was authored by M.L. Schwandt, V.A. Ramchandani, J. Upadhyay, C. Ramsden, N. Diazgranados, and D. Goldman.