Alcohol use as non-prescribed pain management

The use of alcohol for pain management can easily become problematic and addictive, resulting in the need for alcohol treatment. Riley and King examined the use of alcohol for pain management among adults with tooth pain, jaw joint or face pain, and arthritis in a South Florida community (2009). The researchers examined race, sex, and age to determine their associations with alcohol use for pain management.

After conducting structured telephone interviews, the researchers found that non-Hispanic whites and males were the most likely to use alcohol to cope with pain. Additionally, alcohol use for pain was highest among younger adults. Individuals who self-medicated with alcohol also tended to have greater pain frequency, depression, and higher levels of education, regardless of the pain condition. Those who self-managed oral pain with alcohol were more likely to also use prescription and over-the-counter pain medications, but this was not the case for individuals with arthritis. Marriage seemed to protect against the use of alcohol for pain management.

The authors of this article suggest that “alcohol use for pain needs to be assessed so that health care providers can make appropriate referrals and adjustments to treatment.” How will a healthcare provider accomplish these tasks? There are more difficulties in these tasks than might first appear.

As to the assessment, a straightforward series of questions might work: “How much have you used alcohol or other drugs to help you cope with the pain? How well did these substances work? Did you feel I was not prescribing enough for pain relief? If I prescribed more, would you be willing to stop the alcohol use? How does your alcohol use for this pain compare to your regular drinking?”

The questions to ask will partly be based on whether the healthcare provider had alerted the patient in advance about not using alcohol to supplement the pain medication. If it seems that alcohol use was minor, the provider might not make a recommendation. However, as this article suggests, significant alcohol (or other drug use) should lead in the direction of further action, which might include a follow-up visit to discuss the issue (with the patient making changes in preparation for that meeting), an evaluation by an addiction professional, or even referral to alcohol treatment or addiction treatment. However, if the patient does not adhere to any of these recommendations, what should the provider do about the pain medications?

What probably will not work is adjusting the patient’s pain medication downward because the patient keeps drinking. Will the patient just increase alcohol use in order to make up for less pain meds?

What is unclear is whether healthcare providers will actually engage in this type of conversation with their patients. Many healthcare providers are reluctant to discuss addiction issues with their patients, or, as in the present study, to suggest that the patient may need alcohol treatment. Perhaps the topic of pain management and alcohol use will be an easier one, but that is a hope more than a reality at this time.

Riley JL, King C. Self-report of alcohol use for pain in a multi-ethnic community sample. Journal of Pain. 2009; 10(9): 944-952.