Ambulatory assessment of physical pain, emotional distress, and alcohol use

[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 patients’ 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 opioids’, 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.