The Relationship of a History of Alcohol Use Disorder to Treatment Completion in Chronic Pain Management

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] The available research suggests that many individuals with chronic pain drink alcohol to manage their pain. However, few studies have examined the association of alcohol and pain and none have done so in patientsâ€™ daily lives. The goal of this project was to test a theoretical framework for why individuals with chronic pain consume alcohol. The project used ambulatory assessment to investigate three interrelated reasons for using alcohol, namely that alcohol: 1) has analgesic effects similar to prescription opioidsâ€™, 2) is negatively reinforcing, and 3) is expected to relieve pain. Secondarily, we examined the relationship of pain and negative affect, and to what degree a baseline pain response obtained during a laboratory task was associated with pain in daily life. Eight-seven outpatients with chronic low back pain (CLBP) who drank alcohol at least twice per week (ALC; n =27), took daily or every-other-day prescribed opioids (OPI; n = 27), neither (NON; n = 26), or both (BOTH; n = 7) were recruited. Analyses focused on the ALC, OPI, and NON groups (n-observations = 6,973). Participants reported on their alcohol and opioid use and expectancies, pain, and negative affect (NA) multiple times daily for two weeks. Results supported the first two hypotheses. There was moderate support that greater pain was associated with later alcohol use, and strong support that alcohol use was associated with pain reductions. Support was also found for the association of opioid use and pain. Effects, though slightly more inconsistent, were also found for NA, suggesting a negative reinforcement process was involved in pain reductions. Contrary to predictions, pain-related expectancies largely did not moderate associations of alcohol and pain, though NA-related expectancies moderated associations of alcohol and NA. Expectancies also moderated the relationship of opioid use with both pain and NA. Thus, the findings suggest that alcohol has meaningful short-term effects in CLBP patients. These effects may put patients at risk for developing alcohol use problems.

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The relationship of the scleractinian corals to the rugose corals

Paleobiology ◽

10.1017/s0094837300025707 ◽

1980 ◽

Vol 6 (02) ◽

pp. 146-160 ◽

Cited By ~ 29

Author(s):

William A. Oliver

Keyword(s):

Critical Points ◽

Scleractinian Corals ◽

Convincing Evidence ◽

Early Triassic ◽

Rugose Corals ◽

History Of ◽

The Subject ◽

Relationship Of ◽

The Relationship ◽

Biologic Factors

The Mesozoic-Cenozoic coral Order Scleractinia has been suggested to have originated or evolved (1) by direct descent from the Paleozoic Order Rugosa or (2) by the development of a skeleton in members of one of the anemone groups that probably have existed throughout Phanerozoic time. In spite of much work on the subject, advocates of the direct descent hypothesis have failed to find convincing evidence of this relationship. Critical points are:(1) Rugosan septal insertion is serial; Scleractinian insertion is cyclic; no intermediate stages have been demonstrated. Apparent intermediates are Scleractinia having bilateral cyclic insertion or teratological Rugosa.(2) There is convincing evidence that the skeletons of many Rugosa were calcitic and none are known to be or to have been aragonitic. In contrast, the skeletons of all living Scleractinia are aragonitic and there is evidence that fossil Scleractinia were aragonitic also. The mineralogic difference is almost certainly due to intrinsic biologic factors.(3) No early Triassic corals of either group are known. This fact is not compelling (by itself) but is important in connection with points 1 and 2, because, given direct descent, both changes took place during this only stage in the history of the two groups in which there are no known corals.

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