Pain Severity and Alcohol Use Among Daily Tobacco Cigarette Smokers

Evaluating Alcohol Use Severity in Terms of Cigarette Smoking-Related Processes and Anxiety/Depression Among Adult Latinx Smokers

OBJECTIVE

Although empirical work focused on smoking-drinking comorbidity among Latinx persons is growing, no work has explored the relation between alcohol use severity in terms of co-occurring smoking processes and mental health. Therefore, the present investigation aimed to explore the prevalence and role of alcohol use severity in relation to clinically significant tobacco and mental health problems among English-speaking Latinx adults who smoke cigarettes.

METHODS

Participants included 338 English-speaking Latinx adults who smoked cigarettes daily (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female).

RESULTS

Results indicated that approximately 68% of male and 61% of female smokers scored above established clinical cutoffs for hazardous and harmful alcohol use and possible alcohol dependence. Moreover, alcohol use severity was associated with increased risk for cigarette dependence, perceived barriers for quitting, and more problematic symptoms when trying to quit. Alcohol use severity was also related to more severe anxiety and depressive symptoms.

CONCLUSIONS

Overall, the current findings suggest that intervening to reduce alcohol use severity may be important to improving smoking cessation and mental health among Latinx persons who smoke.

Prevalence and influencing factors of chronic pain in middle-aged and older adults in China: results of a nationally representative survey

Background

With China's rapidly aging population, chronic pain has become a major public health issue. This article aims at determining associations between chronic pain and multiple factors, including demographic characteristics, health status, and health service utilization of middle-aged and older adults in China.

Methods

We selected all the 19,829 respondents who were over 45 years old from the China Health and Aging Tracking Survey 2018 (CHARLS) as our study population. The key information in terms of the body pain, demographic characteristics, health status, behaviors and health services use was extracted and analyzed. Logistic regression model was used to determine the influencing factors of chronic pain.

Results

Analysis revealed that 60.02% (9,257) of the data from this survey reported physical pain, with pain sites concentrated at the head (40.9%), lower back (62.2%) and knees (47.2%). Pain was positively associated with influencing factors for pain: being a female (OR = 2.10, 95% CI 1.90-2.33, p < 0.001), living in a western region (OR = 1.28, 95% CI 1.16-1.41, p < 0.001), living in a rural area (OR = 1.14, 95% CI 1.06-1.23, p < 0.001), smoked (OR = 1.26, 95% CI 1.14-1.38, p < 0.001), drank alcohol (OR = 1.16, 95% CI 1.06-1.26, p = 0.001), and had poor self-rated health (OR = 6.84, 95% CI 5.41-8.65, p < 0.001), had hearing problems (OR = 1.23, 95% CI 1.11-3.37, p < 0.001), were depressed (OR = 1.56, 95% CI 1.03-1.29, p < 0.001), had arthritis (OR = 2.21, 95% CI 2.02-2.41, p < 0.001), stomach disorders (OR = 1.69, 95% CI 1.55-1.85, p < 0.001), visited a Western medicine hospital (OR = 1.28, 95% CI 1.10-1.50, p = 0.002), and visits to other medical institutions (OR = 1.42, 95%CI 1.22-1.64, p < 0.001). On the other side, as a protective factor for pain, having nighttime sleep ≥7 h (OR = 0.74, 95%CI 0.68-0.80, p < 0.001) was negatively associated with pain.

Conclusion

Physical pain affects many older adults. Women, regional, rural residents, smokers, alcohol drinkers, people with poor self-rated health, those having <7 h of sleep at night, those with hearing problems, depression, arthritis, stomach disorders, and people who visits Western hospitals or other medical institutions are at greater risk for pain and deserve the attention of health care providers and policy makers to focus on pain prevention and management in middle-aged and older adults. Future research studies should also focus on the impact of health literacy on pain prevention and management outcomes.

Pain Severity and Interference and Substance Use Among Community Pharmacy Patients Prescribed Opioids: A Secondary Analysis of the PHARMSCREEN Study

This secondary analysis examined relationships between pain severity and interference and substance use among patients filling opioid prescriptions in Indiana and Ohio community pharmacies (n = 1,461). We likewise sought to explore the moderating role of gender in pain-substance use relations. We used patient-reported data from a cross-sectional health survey linked with controlled substance dispensing data from statewide prescription drug monitoring programs. Multivariable logistic regression estimated associations between pain severity and interference and various indices of risky prescription opioid use and non-opioid substance use. Exploratory analyses examined whether gender moderated associations. Increased pain severity was associated with increased odds of moderate- to high-risk opioid use (OR: 1.23; 95% CI: 1.16-1.31) and opioid-benzodiazepine co-use (OR: 1.20; 95% CI: 1.03-1.40). Increased pain interference was associated with greater odds of receiving opioids from multiple pharmacies or providers (OR: 1.15; 95% CI: 1.01-1.31). Increased pain severity and interference were associated with higher odds of any tobacco use (severity: OR: 1.13; 95% CI: 1.06-1.21; interference: OR: 1.07; 95% CI: 1.01-1.12) and weekly to daily sedative use (severity: OR: 1.13; 95% CI: 1.03-1.25; interference: OR: 1.13; 95% CI: 1.04-1.22). Increased pain severity was associated with decreased odds of any alcohol use (OR: 0.93; 95% CI: 0.88-0.99). Gender was a significant effect modifier in associations between pain and alcohol, tobacco, and cannabis use. The study was registered in the database of clinicaltrials.gov (register number NCT03936985). Perspective: This study suggests that pain severity and interference are associated with increased use of non-medical prescription opioids, sedatives, and tobacco and decreased use of alcohol, in ways that are different between women and men. Findings may guide the development of gender-sensitive evidence-based strategies to ameliorate or prevent substance misuse among patients living with pain.

Cognitive-Affective Transdiagnostic Factors Associated With Vulnerability to Alcohol and Prescription Opioid Use in the Context of Pain

The use of alcohol and prescription opioids is common among people in pain and poses significant public health burdens. This review identifies factors associated with motivation to use alcohol and prescription opioids in the context of pain. Pain-relevant, cognitive-affective, transdiagnostic vulnerability factors-expectancies/motives, pain catastrophizing, pain-related anxiety, distress intolerance, anxiety sensitivity, and perceived interrelations-were selected from theoretical conceptualizations of pain and substance use. Searches conducted in PubMed, PsycINFO, and Embase returned 25 studies that examined associations between identified variables of interest and the use of alcohol and prescription opioids in the context of pain. Consistent with a larger literature on pain and substance use, the studies included in this review demonstrated that people with chronic pain are motivated to use alcohol and opioids in response to negative affect and hold expectancies/motives for coping with pain. Vulnerabilities that engender difficulty managing aversive internal states (distress intolerance and anxiety sensitivity) and maladaptive responses to pain (pain-related anxiety and pain catastrophizing) also were implicated in motivation for alcohol and opioid use. Although one study found that pain-related anxiety was associated with co-use of alcohol and opioids, no studies examined simultaneous use. Future research directions that can explicate causal associations, identify patterns of alcohol and opioid co-use, clarify the role of pain in cessation processes, and inform treatment development are discussed.

Pain-related anxiety, sex, and co-use of alcohol and prescription opioids among adults with chronic low back pain

BACKGROUND

Both alcohol and prescription opioid use/misuse are highly prevalent among individuals with chronic pain. Co-use of alcohol and prescription opioids is also common, despite contraindications due to increased risk of negative health effects and mortality. There is evidence that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with heavier drinking and prescription opioid use/co-use, and that these associations may be especially salient among men.

METHODS

This study is the first examination of pain-related anxiety in relation to hazardous alcohol use, prescription opioid use/misuse, and alcohol-opioid co-use. Participants included 1812 adults with chronic low back pain (69 % female, Mage = 43.95) who completed an online survey assessing health behaviors.

RESULTS

Pain-related anxiety was positively associated with indices of alcohol (i.e., alcohol-related consequences) and opioid use (i.e., prescription opioid use/misuse, daily opioid consumption). Of note, sex moderated associations between pain-related anxiety and both alcohol-related consequences and prescription opioid misuse. In addition to being associated with alcohol and prescription opioid use, independently, pain-related anxiety was also associated with greater likelihood of endorsing co-use of alcohol and opioids and engaging in concurrent hazardous drinking and prescription opioid misuse.

CONCLUSIONS

These findings contribute to a growing literature suggesting that pain-related anxiety is an important transdiagnostic factor in pain and alcohol and prescription opioid use/co-use, perhaps especially among males.

Neuropeptide and cytokine regulation of pain in the context of substance use disorders

Substance use disorders (SUDs) are frequently accompanied by affective symptoms that promote negative reinforcement mechanisms contributing to SUD maintenance or progression. Despite their widespread use as analgesics, chronic or excessive exposure to alcohol, opioids, and nicotine produces heightened nociceptive sensitivity, termed hyperalgesia. This review focuses on the contributions of neuropeptide (CRF, melanocortin, opioid peptide) and cytokine (IL-1β, TNF-α, chemokine) systems in the development and maintenance of substance-induced hyperalgesia. Few effective therapies exist for either chronic pain or SUD, and the common interaction of these disease states likely complicates their effective treatment. Here we highlight promising new discoveries as well as identify gaps in research that could lead to more effective and even simultaneous treatment of SUDs and co-morbid hyperalgesia symptoms.