Managing Pain in Patients With Comorbid Alcohol Use Disorder and Chronic Pain

This narrative review describes the management of patients experiencing alcohol use disorder (AUD) and co-occurring chronic pain (CP). An overview of the epidemiology and pathophysiology of both conditions is provided, including the potential overlapping mechanisms in the central nervous system (CNS). Pharmacological and nonpharmacological treatment approaches for both conditions are discussed, including mechanisms of action and the potential for adverse effects. Additionally, social and psychological factors influencing both conditions are reviewed. The need for additional research on the underlying mechanisms of comorbidity and the development of personalized treatment strategies for both disorders are highlighted.

The prevalence of chronic excessive alcohol use is relatively high among adult patients with CP conditions, and the prevalence of CP is increased in patients with AUD. Much evidence suggests that the mechanisms underlying AUD and the processes involved in the dysregulation of pain signaling potentially intersect. There is overlap in some nonpharmacological treatments that are used for treating both AUD and CP, specifically those that involve cognitive and behavioral interventions. Several classes of prescribed pain medications can interact with alcohol, including anti-inflammatory agents, muscle relaxants, and opioid analgesics; these therapies can be harmful to patients with AUD. Extra caution should be exercised in prescribing them to patients with AUD.

AUD and CP are two disabling conditions that frequently co-occur. Research is needed to understand the overlaps in pathophysiology and provide better treatment to patients living with both conditions.