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

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Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

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References

  1. NIAAA: Understanding alcohol use disorder.https://http://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder (2021). Accessed April 2023.

  2. Cooper ML, Frone MR, Russell M, Mudar P. Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol. 1995;69(5):990–1005. https://doi.org/10.1037//0022-3514.69.5.990.

    Article  CAS  PubMed  Google Scholar 

  3. Koob GF, Le Moal M. Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology. 2001;24(2):97–129. https://doi.org/10.1016/s0893-133x(00)00195-0.

    Article  CAS  PubMed  Google Scholar 

  4. IASP. International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement. Pain. 2021;162(Suppl 1):S1–2. https://doi.org/10.1097/j.pain.0000000000002265.

    Article  Google Scholar 

  5. Zale EL, Maisto SA, Ditre JW. Interrelations between pain and alcohol: an integrative review. Clin Psychol Rev. 2015;37:57–71. https://doi.org/10.1016/j.cpr.2015.02.005.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ditre JW, LaRowe LR, Powers JM, White KM, Paladino MB, Zvolensky MJ, et al. Pain as a causal motivator of alcohol consumption: associations with gender and race. J Psychopathol Clin Sci. 2023;132(1):101–9. https://doi.org/10.1037/abn0000792.

    Article  PubMed  Google Scholar 

  7. White KM, Hess JL, Glatt SJ, Maisto SA, Zvolensky MJ, Ditre JW. Polygenic risk for alcohol consumption and multisite chronic pain: associations with ad lib drinking behavior. Exp Clin Psychopharmacol. 2023;31(5):933–41. https://doi.org/10.1037/pha0000630.

    Article  CAS  PubMed  Google Scholar 

  8. Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, et al. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the united states, 2001–2002 to 2012–2013: results from the national epidemiologic survey on alcohol and related conditions. JAMA Psychiat. 2017;74(9):911–23. https://doi.org/10.1001/jamapsychiatry.2017.2161.

    Article  Google Scholar 

  9. Rikard SM, Strahan AE, Schmit KM, Guy GPJ. Chronic pain among adults — United States, 2019–2021. In: MMWR Morbidity and mortality weekly report. CDC; 2023. p. 379–85.

    Google Scholar 

  10. Brennan PL, Schutte KK, Moos RH. Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers. Addiction. 2005;100(6):777–86. https://doi.org/10.1111/j.1360-0443.2005.01074.x.

    Article  PubMed  Google Scholar 

  11. Von Korff M, Crane P, Lane M, Miglioretti DL, Simon G, Saunders K, et al. Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication. Pain. 2005;113(3):331–9. https://doi.org/10.1016/j.pain.2004.11.010.

    Article  Google Scholar 

  12. LaRowe LR, Powers JM, Garey L, Rogers AH, Zvolensky MJ, Ditre JW. Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain. Drug Alcohol Depend. 2020;214:108171. https://doi.org/10.1016/j.drugalcdep.2020.108171.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Maleki N, Tahaney K, Thompson BL, Oscar-Berman M. At the intersection of alcohol use disorder and chronic pain. Neuropsychology. 2019;33(6):795–807. https://doi.org/10.1037/neu0000558.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Egli M, Koob GF, Edwards S. Alcohol dependence as a chronic pain disorder. Neurosci Biobehav Rev. 2012;36(10):2179–92. https://doi.org/10.1016/j.neubiorev.2012.07.010.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bushnell MC, Ceko M, Low LA. Cognitive and emotional control of pain and its disruption in chronic pain. Nat Rev Neurosci. 2013;14(7):502–11. https://doi.org/10.1038/nrn3516.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010;35(1):217–38. https://doi.org/10.1038/npp.2009.110.

    Article  PubMed  Google Scholar 

  17. Dupuy M, Chanraud S. Imaging the addicted brain: alcohol. Int Rev Neurobiol. 2016;129:1–31. https://doi.org/10.1016/bs.irn.2016.04.003.

    Article  CAS  PubMed  Google Scholar 

  18. Mitchell JM, O’Neil JP, Janabi M, Marks SM, Jagust WJ, Fields HL. Alcohol consumption induces endogenous opioid release in the human orbitofrontal cortex and nucleus accumbens. Sci Transl Med. 2012;4(116):116ra6. https://doi.org/10.1126/scitranslmed.3002902.

    Article  CAS  PubMed  Google Scholar 

  19. Hartwig AC. Peripheral beta-endorphin and pain modulation. Anesth Prog. 1991;38(3):75–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Edwards S, Koob GF. Neurobiology of dysregulated motivational systems in drug addiction. Future Neurol. 2010;5(3):393–401. https://doi.org/10.2217/fnl.10.14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Le Magnen J, Marfaing-Jallat P, Miceli D, Devos M. Pain modulating and reward systems: a single brain mechanism? Pharmacol Biochem Behav. 1980;12(5):729–33. https://doi.org/10.1016/0091-3057(80)90157-4.

    Article  PubMed  Google Scholar 

  22. Franklin KB. Analgesia and abuse potential: an accidental association or a common substrate? Pharmacol Biochem Behav. 1998;59(4):993–1002. https://doi.org/10.1016/s0091-3057(97)00535-2.

    Article  CAS  PubMed  Google Scholar 

  23. Navratilova E, Xie JY, Okun A, Qu C, Eyde N, Ci S, et al. Pain relief produces negative reinforcement through activation of mesolimbic reward-valuation circuitry. Proc Natl Acad Sci USA. 2012;109(50):20709–13. https://doi.org/10.1073/pnas.1214605109.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Khantzian EJ. Self-regulation and self-medication factors in alcoholism and the addictions. Similarities and differences. Recent Dev Alcohol. 1990;8:255–71.

    CAS  PubMed  Google Scholar 

  25. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry. 1997;4(5):231–44. https://doi.org/10.3109/10673229709030550.

    Article  CAS  PubMed  Google Scholar 

  26. Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain. 2009;10(11):1113–20. https://doi.org/10.1016/j.jpain.2009.09.001.

    Article  PubMed  Google Scholar 

  27. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014;8(2):143–51. https://doi.org/10.1097/spc.0000000000000055.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Apkarian AV, Bushnell MC, Treede RD, Zubieta JK. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain (London, England). 2005;9(4):463–84. https://doi.org/10.1016/j.ejpain.2004.11.001.

    Article  Google Scholar 

  29. Seminowicz DA, Moayedi M. The dorsolateral prefrontal cortex in acute and chronic pain. J Pain. 2017;18(9):1027–35. https://doi.org/10.1016/j.jpain.2017.03.008.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hoffmann NG, Olofsson O, Salen B, Wickstrom L. Prevalence of abuse and dependency in chronic pain patients. Int J Addict. 1995;30(8):919–27. https://doi.org/10.3109/10826089509055820.

    Article  CAS  PubMed  Google Scholar 

  31. Zvolensky MJ, Shepherd JM, Clausen BK, Smit T, Redmond BY, Ditre JW. Alcohol use severity in relation to pain severity and interference among latinx adults with current pain who smoke cigarettes. J Behav Med. 2023;46(6):940–7. https://doi.org/10.1007/s10865-023-00428-4.

    Article  PubMed  Google Scholar 

  32. Dhingra LK, Homel P, Grossman B, Chen J, Scharaga E, Calamita S, et al. Ecological momentary assessment of smoking behavior in persistent pain patients. Clin J Pain. 2014;30(3):205–13. https://doi.org/10.1097/AJP.0b013e31829821c7.

    Article  PubMed  Google Scholar 

  33. Sheu R, Lussier D, Rosenblum A, Fong C, Portenoy J, Joseph H, et al. Prevalence and characteristics of chronic pain in patients admitted to an outpatient drug and alcohol treatment program. Pain Med (Malden, Mass). 2008;9(7):911–7. https://doi.org/10.1111/j.1526-4637.2008.00420.x.

    Article  Google Scholar 

  34. Boissoneault J, Lewis B, Nixon SJ. Characterizing chronic pain and alcohol use trajectory among treatment-seeking alcoholics. Alcohol (Fayetteville, NY). 2019;75:47–54. https://doi.org/10.1016/j.alcohol.2018.05.009.

    Article  Google Scholar 

  35. Chopra K, Tiwari V. Alcoholic neuropathy: possible mechanisms and future treatment possibilities. Br J Clin Pharmacol. 2012;73(3):348–62. https://doi.org/10.1111/j.1365-2125.2011.04111.x.

    Article  CAS  PubMed  Google Scholar 

  36. Portenoy RK. A practical approach to using adjuvant analgesics in older adults. J Am Geriatr Soc. 2020;68(4):691–8. https://doi.org/10.1111/jgs.16340.

    Article  PubMed  Google Scholar 

  37. Fitzgerald Jones K, Khodyakov D, Arnold R, Bulls H, Dao E, Kapo J, et al. Consensus-based guidance on opioid management in individuals with advanced cancer-related pain and opioid misuse or use disorder. JAMA Oncol. 2022;8(8):1107–14. https://doi.org/10.1001/jamaoncol.2022.2191.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nickels K, Broglio K, Rosielle D, Holbein M, Ho J. From diagnosis til death do we part: palliative care, harm reduction, and the management of pain and opioid use disorder across the care continuum (TH140). J Pain Symptom Manage. 2022;63(5):793. https://doi.org/10.1016/j.jpainsymman.2022.02.223.

    Article  Google Scholar 

  39. Ricciotti E, FitzGerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011;31(5):986–1000. https://doi.org/10.1161/atvbaha.110.207449.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kim M, Lee EJ, Lim KM. Ibuprofen increases the hepatotoxicity of ethanol through potentiating oxidative stress. Biomol Ther. 2021;29(2):205–10. https://doi.org/10.4062/biomolther.2020.108.

    Article  CAS  Google Scholar 

  41. Neutel CI, Appel WC. The effect of alcohol abuse on the risk of NSAID-related gastrointestinal events. Ann Epidemiol. 2000;10(4):246–50. https://doi.org/10.1016/s1047-2797(00)00040-5.

    Article  CAS  PubMed  Google Scholar 

  42. Kelly JP, Kaufman DW, Koff RS, Laszlo A, Wiholm BE, Shapiro S. Alcohol consumption and the risk of major upper gastrointestinal bleeding. Am J Gastroenterol. 1995;90(7):1058–64.

    CAS  PubMed  Google Scholar 

  43. Kovalak M, Lake J, Mattek N, Eisen G, Lieberman D, Zaman A. Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic database. Gastrointest Endosc. 2007;65(1):82–8. https://doi.org/10.1016/j.gie.2006.08.023.

    Article  PubMed  Google Scholar 

  44. Robinson C, Dalal S, Chitneni A, Patil A, Berger AA, Mahmood S, et al. A look at commonly utilized serotonin noradrenaline reuptake inhibitors (SNRIs) in chronic pain. Health Psychol Res. 2022;10(3):32309. https://doi.org/10.52965/001c.32309.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lamont LA, Tranquilli WJ, Grimm KA. Physiology of pain. Vet Clin North Am Small Animal Pract. 2000;30(4):703–28. https://doi.org/10.1016/s0195-5616(08)70003-2.

    Article  CAS  Google Scholar 

  46. Ferreira GE, McLachlan AJ, Lin CC, Zadro JR, Abdel-Shaheed C, O’Keeffe M, et al. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. BMJ (Clinical research ed). 2021;372:m4825. https://doi.org/10.1136/bmj.m4825.

    Article  PubMed  Google Scholar 

  47. DeVido JJ, Weiss RD. Treatment of the depressed alcoholic patient. Curr Psychiatry Rep. 2012;14(6):610–8. https://doi.org/10.1007/s11920-012-0314-7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. Cochrane Database Syst Rev. 2018;4(4):CD008581. https://doi.org/10.1002/14651858.CD008581.pub2.

    Article  PubMed  Google Scholar 

  49. Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013;2013(11):CD010567. https://doi.org/10.1002/14651858.CD010567.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hammond CJ, Niciu MJ, Drew S, Arias AJ. Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders. CNS Drugs. 2015;29(4):293–311. https://doi.org/10.1007/s40263-015-0240-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Corrigan R, Derry S, Wiffen PJ, Moore RA. Clonazepam for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2012;2012(5):CD009486. https://doi.org/10.1002/14651858.CD009486.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Park HJ, Moon DE. Pharmacologic management of chronic pain. Korean J Pain. 2010;23(2):99–108. https://doi.org/10.3344/kjp.2010.23.2.99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Beebe FA, Barkin RL, Barkin S. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther. 2005;12(2):151–71. https://doi.org/10.1097/01.mjt.0000134786.50087.d8.

    Article  PubMed  Google Scholar 

  54. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–30. https://doi.org/10.1016/j.jpain.2008.10.008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Passik SD, Kirsh KL, Whitcomb L, Portenoy RK, Katz NP, Kleinman L, et al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004;26(4):552–61. https://doi.org/10.1016/s0149-2918(04)90057-4.

    Article  CAS  PubMed  Google Scholar 

  56. Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008;16(5):405–16. https://doi.org/10.1037/a0013628.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pathan H, Williams J. Basic opioid pharmacology: an update. Br J Pain. 2012;6(1):11–6. https://doi.org/10.1177/2049463712438493.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ossipov MH, Dussor GO, Porreca F. Central modulation of pain. J Clin Investig. 2010;120(11):3779–87. https://doi.org/10.1172/jci43766.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Sommer C, Klose P, Welsch P, Petzke F, Häuser W. Opioids for chronic non-cancer neuropathic pain. An updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks duration. Eur J Pain (London, England). 2020;24(1):3–18. https://doi.org/10.1002/ejp.1494.

    Article  Google Scholar 

  60. Harati Y, Gooch C, Swenson M, Edelman SV, Greene D, Raskin P, et al. Maintenance of the long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy. J Diabetes Complications. 2000;14(2):65–70. https://doi.org/10.1016/s1056-8727(00)00060-x.

    Article  CAS  PubMed  Google Scholar 

  61. Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872–82. https://doi.org/10.1001/jama.2018.0899.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Wakaizumi K, Vigotsky AD, Jabakhanji R, Abdallah M, Barroso J, Schnitzer TJ, et al. Psychosocial, functional, and emotional correlates of long-term opioid use in patients with chronic back pain: a cross-sectional case-control study. Pain Ther. 2021;10(1):691–709. https://doi.org/10.1007/s40122-021-00257-w.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Turk DC, Swanson KS, Gatchel RJ. Predicting opioid misuse by chronic pain patients: a systematic review and literature synthesis. Clin J Pain. 2008;24(6):497–508. https://doi.org/10.1097/AJP.0b013e31816b1070.

    Article  PubMed  Google Scholar 

  64. Walden M, Nicholls FA, Smith KJ, Tucker GT. The effect of ethanol on the release of opioids from oral prolonged-release preparations. Drug Dev Ind Pharm. 2007;33(10):1101–11. https://doi.org/10.1080/03639040701377292.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Murphy L, Ng KW, Su V, Woodworth-Giroux S, Levy TS, Sproule BA, et al. Approach to the pharmacological management of chronic pain in patients with an alcohol use disorder. J Pain Res. 2015;8:851–7. https://doi.org/10.2147/jpr.s88900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. Prescribing opioids for pain - the new CDC clinical practice guideline. N Engl J Med. 2022;387(22):2011–3. https://doi.org/10.1056/NEJMp2211040.

    Article  PubMed  Google Scholar 

  67. Williams ACC, Fisher E, Hearn L, Eccleston C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020;8(8):CD007407. https://doi.org/10.1002/14651858.CD007407.pub4.

    Article  PubMed  Google Scholar 

  68. Taherkhani S, Suzuki K, Castell L. A short overview of changes in inflammatory cytokines and oxidative stress in response to physical activity and antioxidant supplementation. Antioxidants (Basel, Switzerland). 2020;9(9). https://doi.org/10.3390/antiox9090886.

  69. Fairbanks J, Umbreit A, Kolla BP, Karpyak VM, Schneekloth TD, Loukianova LL, et al. Evidence-based pharmacotherapies for alcohol use disorder: clinical pearls. Mayo Clin Proc. 2020;95(9):1964–77. https://doi.org/10.1016/j.mayocp.2020.01.030.

    Article  CAS  PubMed  Google Scholar 

  70. White W. Slaying the dragon: the history of addiction treatment and recovery in America, 2nd edn. Bloomington, IL: Chestnut Health Systems; 2014. https://scholar.google.com/scholar_lookup?title=Slaying+the+Dragon:+The+history+of+Addiction+Treatment+and+Recovery+in+America&author=.

  71. Witkiewitz K, Litten RZ, Leggio L. Advances in the science and treatment of alcohol use disorder. Sci Adv. 2019;5(9):eaax4043. https://doi.org/10.1126/sciadv.aax4043.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. McMahon FG. Disulfiram-like reaction to a cephalosporin. Jama. 1980;243(23):2397.

    Article  CAS  PubMed  Google Scholar 

  73. Fuller RK, Branchey L, Brightwell DR, Derman RM, Emrick CD, Iber FL, et al. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. Jama. 1986;256(11):1449–55.

    Article  CAS  PubMed  Google Scholar 

  74. Chick J, Gough K, Falkowski W, Kershaw P, Hore B, Mehta B, et al. Disulfiram treatment of alcoholism. Br J Psychiatry. 1992;161:84–9. https://doi.org/10.1192/bjp.161.1.84.

    Article  CAS  PubMed  Google Scholar 

  75. Allen JP, Litten RZ. Techniques to enhance compliance with disulfiram. Alcohol Clin Exp Res. 1992;16(6):1035–41. https://doi.org/10.1111/j.1530-0277.1992.tb00695.x.

    Article  CAS  PubMed  Google Scholar 

  76. Litten RZ, Castle IJ, Falk D, Ryan M, Fertig J, Chen CM, et al. The placebo effect in clinical trials for alcohol dependence: an exploratory analysis of 51 naltrexone and acamprosate studies. Alcohol Clin Exp Res. 2013;37(12):2128–37. https://doi.org/10.1111/acer.12197.

    Article  CAS  PubMed  Google Scholar 

  77. Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889–900. https://doi.org/10.1001/jama.2014.3628.

    Article  CAS  PubMed  Google Scholar 

  78. Kranzler HR, Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: a review. JAMA. 2018;320(8):815–24. https://doi.org/10.1001/jama.2018.11406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Heinz A, Lober S, Georgi A, Wrase J, Hermann D, Rey ER, et al. Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake. Alcohol Alcohol. 2003;38(1):35–9. https://doi.org/10.1093/alcalc/agg005.

    Article  PubMed  Google Scholar 

  80. Gianoulakis C. Implications of endogenous opioids and dopamine in alcoholism: human and basic science studies. Alcohol Alcohol Suppl. 1996;31(1):33–42.

    Article  CAS  PubMed  Google Scholar 

  81. Maisel NC, Blodgett JC, Wilbourne PL, Humphreys K, Finney JW. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction. 2013;108(2):275–93. https://doi.org/10.1111/j.1360-0443.2012.04054.x.

    Article  PubMed  Google Scholar 

  82. O’Malley SS, Jaffe AJ, Chang G, Schottenfeld RS, Meyer RE, Rounsaville B. Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry. 1992;49(11):881–7. https://doi.org/10.1001/archpsyc.1992.01820110045007.

    Article  PubMed  Google Scholar 

  83. Garbutt JC, Kranzler HR, O’Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005;293(13):1617–25. https://doi.org/10.1001/jama.293.13.1617.

    Article  CAS  PubMed  Google Scholar 

  84. Krystal JH, Staley J, Mason G, Petrakis IL, Kaufman J, Harris RA, et al. Gamma-aminobutyric acid type A receptors and alcoholism: intoxication, dependence, vulnerability, and treatment. Arch Gen Psychiatry. 2006;63(9):957–68. https://doi.org/10.1001/archpsyc.63.9.957.

    Article  CAS  PubMed  Google Scholar 

  85. Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010;9:Cd004332. https://doi.org/10.1002/14651858.CD004332.pub2.

    Article  Google Scholar 

  86. Karpyak VM, Biernacka JM, Geske JR, Jenkins GD, Cunningham JM, Rüegg J, et al. Genetic markers associated with abstinence length in alcohol-dependent subjects treated with acamprosate. Transl Psychiatry. 2014;4(10):e462. https://doi.org/10.1038/tp.2014.103.

    Article  CAS  PubMed  Google Scholar 

  87. Soyka M, Müller CA. Pharmacotherapy of alcoholism - an update on approved and off-label medications. Expert Opin Pharmacother. 2017;18(12):1187–99. https://doi.org/10.1080/14656566.2017.1349098.

    Article  CAS  PubMed  Google Scholar 

  88. Toljan K, Vrooman B. Low-dose naltrexone (LDN)-review of therapeutic utilization. Med Sci (Basel, Switzerland). 2018;6(4). https://doi.org/10.3390/medsci6040082.

  89. Magill M, Kiluk BD, McCrady BS, Tonigan JS, Longabaugh R. Active ingredients of treatment and client mechanisms of change in behavioral treatments for alcohol use disorders: progress 10 years later. Alcohol Clin Exp Res. 2015;39(10):1852–62. https://doi.org/10.1111/acer.12848.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Witkiewitz K, Marlatt A. Behavioral therapy across the spectrum. Alcohol Res Health. 2011;33(4):313–9.

    PubMed  PubMed Central  Google Scholar 

  91. Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, et al. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: treatment efficacy by contrast condition. J Consult Clin Psychol. 2019;87(12):1093–105. https://doi.org/10.1037/ccp0000447.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(6):e208279. https://doi.org/10.1001/jamanetworkopen.2020.8279.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive behavioral therapy for depression. Indian J Psychiatry. 2020;62(Suppl 2):S223–9. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Wilson AD, Roos CR, Robinson CS, Stein ER, Manuel JA, Enkema MC, et al. Mindfulness-based interventions for addictive behaviors: implementation issues on the road ahead. Psychol Addict Behav. 2017;31(8):888–96. https://doi.org/10.1037/adb0000319.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Kiluk BD, Devore KA, Buck MB, Nich C, Frankforter TL, LaPaglia DM, et al. Randomized trial of computerized cognitive behavioral therapy for alcohol use disorders: efficacy as a virtual stand-alone and treatment add-on compared with standard outpatient treatment. Alcohol Clin Exp Res. 2016;40(9):1991–2000. https://doi.org/10.1111/acer.13162.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiat. 2014;71(5):566–72. https://doi.org/10.1001/jamapsychiatry.2013.4642.

    Article  Google Scholar 

  97. Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med. 2017;51(2):199–213. https://doi.org/10.1007/s12160-016-9844-2.

    Article  PubMed  Google Scholar 

  98. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020;3(3):CD012880. https://doi.org/10.1002/14651858.CD012880.pub2.

    Article  PubMed  Google Scholar 

  99. MATCH. Matching alcoholism treatments to client heterogeneity: project MATCH posttreatment drinking outcomes. J Stud Alcohol. 1997;58(1):7–29.

    Article  Google Scholar 

  100. Witkiewitz K, Marlatt GA. Relapse prevention for alcohol and drug problems: that was Zen, this is Tao. Am Psychol. 2004;59(4):224–35. https://doi.org/10.1037/0003-066x.59.4.224.

    Article  PubMed  Google Scholar 

  101. ASBI C: Alcohol screening and brief intervention for people who consume alcohol and use opioids. https://http://www.cdc.gov/alcohol/fact-sheets/alcohol-screening.html Accessed April 12, 2023 2023.

  102. Parish WJ, Mark TL, Weber EM, Steinberg DG. Substance use disorders among Medicare beneficiaries: prevalence, mental and physical comorbidities, and treatment barriers. Am J Prev Med. 2022;63(2):225–32. https://doi.org/10.1016/j.amepre.2022.01.021.

    Article  PubMed  Google Scholar 

  103. HHS. Medicare coverable services for integrative and nonpharmacological chronic pain management In: Services USDoHH. U.S. Dept. of Health & Human Services; 2021. https://www.hhs.gov/guidance/document/medicare-coverable-services-integrative-and-non-pharmacological-chronic-pain-management.

  104. Edlund MJ, Martin BC, Devries A, Fan MY, Braden JB, Sullivan MD. Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study. Clin J Pain. 2010;26(1):1–8. https://doi.org/10.1097/AJP.0b013e3181b99f35.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Adelmann PK. Mental and substance use disorders among Medicaid recipients: prevalence estimates from two national surveys. Adm Policy Ment Health. 2003;31(2):111–29. https://doi.org/10.1023/b:apih.0000003017.78877.56.

    Article  PubMed  Google Scholar 

  106. Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, et al. Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001–6. https://doi.org/10.15585/mmwr.mm6736a2.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Derry S, Moore RA, Gaskell H, McIntyre M, Wiffen PJ. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015;2015(6):CD007402. https://doi.org/10.1002/14651858.CD007402.pub3.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Makris UE, Kohler MJ, Fraenkel L. Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review. J Rheumatol. 2010;37(6):1236–43. https://doi.org/10.3899/jrheum.090935.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Ghlichloo I, Gerriets V. Nonsteroidal anti-inflammatory drugs (NSAIDs). StatPearls. Treasure Island FL: © 2023, StatPearls Publishing LLC; 2023.

    Google Scholar 

  110. Yasaei R, Katta S, Saadabadi A. Saadabadi. StatPearls. Treasure Island FL: © 2023, StatPearls Publishing LLC; 2023.

    Google Scholar 

  111. Cambron JA, Dexheimer J, Coe P, Swenson R. Side-effects of massage therapy: a cross-sectional study of 100 clients. J Altern Complement Med (New York, NY). 2007;13(8):793–6. https://doi.org/10.1089/acm.2006.6401.

    Article  Google Scholar 

  112. Dindo L, Van Liew JR, Arch JJ. Acceptance and commitment therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546–53. https://doi.org/10.1007/s13311-017-0521-3.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Binda DD, Greco CM, Morone NE. What are adverse events in mindfulness meditation? Global Ad Health Med. 2022;11:2164957X221096640. https://doi.org/10.1177/2164957x221096640.

    Article  Google Scholar 

  114. Ernst E. Acupuncture - a treatment to die for? J R Soc Med. 2010;103(10):384–5. https://doi.org/10.1258/jrsm.2010.100181.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Wackernah RC, Minnick MJ, Clapp P. Alcohol use disorder: pathophysiology, effects, and pharmacologic options for treatment. Substance Abuse Rehabil. 2014;5:1–12. https://doi.org/10.2147/sar.s37907.

    Article  Google Scholar 

  116. Volpicelli JR, Volpicelli LA, O’Brien CP. Medical management of alcohol dependence: clinical use and limitations of naltrexone treatment. Alcohol Alcohol. 1995;30(6):789–98.

    CAS  PubMed  Google Scholar 

  117. Ruiz FJ, Luciano C, Flórez CL, Suárez-Falcón JC, Cardona-Betancourt V. A multiple-baseline evaluation of acceptance and commitment therapy focused on repetitive negative thinking for comorbid generalized anxiety disorder and depression. Front Psychol. 2020;11:356. https://doi.org/10.3389/fpsyg.2020.00356.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Walters GD. Twelve reasons why we need to find alternatives to Alcoholics Anonymous. Addict Disord Treat. 2002;1(2):53–9.

    Article  Google Scholar 

  119. Kouimtsidis C, Pauly B, Parkes T, Stockwell T, Baldacchino AM. COVID-19 social restrictions: an opportunity to re-visit the concept of harm reduction in the treatment of alcohol dependence. A position paper. Front Psychiatry. 2021;12:623649. https://doi.org/10.3389/fpsyt.2021.623649.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Marlatt GA, Witkiewitz K. Update on harm-reduction policy and intervention research. Annu Rev Clin Psychol. 2010;6:591–606. https://doi.org/10.1146/annurev.clinpsy.121208.131438.

    Article  PubMed  Google Scholar 

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Funding

The writing of this paper was supported by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) K01 AA027833 and National Institute of Nursing Research (NINR) R01 NR020601.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Nasim Maleki, Benjamin L. Thompson & Kathryn Janiuk

  2. VA Boston Healthcare System, Boston, MA, USA

    Nasim Maleki

  3. Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA

    Lara Dhingra

  4. MJHS Institute for Innovation in Palliative Care, New York, NY, USA

    Lara Dhingra

  5. MGH Center for Pain Medicine and MGH Center for Translational Pain Research, Harvard Medical School, Boston, MA, USA

    Lucy Chen

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Maleki, N., Thompson, B.L., Janiuk, K. et al. Managing Pain in Patients With Comorbid Alcohol Use Disorder and Chronic Pain. Curr Addict Rep (2024). https://doi.org/10.1007/s40429-024-00563-1

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