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Aghabeigi S, Bush NJ, Boissoneault J. Determinants of perceived pain relief from acute alcohol intake in a laboratory setting. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 12:100267. [PMID: 39219736 PMCID: PMC11363492 DOI: 10.1016/j.dadr.2024.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/17/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
Background Studies of alcohol analgesia often assume that changes in pain sensitivity reflect the negative reinforcing effects of alcohol in pain self-management. However, factors that may influence perceived pain relief due to alcohol use remain incompletely characterized. Thus, the primary aim of this study was to identify which factors are most strongly related to self-reported pain relief in individuals with and without chronic pain after alcohol consumption. Methods This study combined data from two studies of alcohol analgesia in individuals who regularly consume alcohol with and without chronic pain. Alcohol analgesia expectancies were assessed during screening. In laboratory sessions, participants received an alcohol-containing (.08 g/dL target BrAC) or placebo beverage and rated subjective intoxication and subjective response (positive/negative aspects of stimulation/sedation). Participants underwent quantitative sensory testing to measure pain intensity, pain threshold, and relief. Paired sample t-tests determined effects of alcohol on pain measures. Hierarchical linear models determined factors associated with pain relief ratings in the alcohol condition. Results Pain relief and pain threshold were higher in the alcohol session relative to placebo, but pain intensity did not differ. In a 4-step hierarchical linear model, expectancy of pain relief, subjective intoxication, and high positive affect, but not pain threshold or pain intensity, were significantly and uniquely associated with perceived relief. Conclusions Taken together, results suggest the negative-reinforcing effects of alcohol for pain-management are not completely reflected by changes in pain sensitivity in a laboratory setting. Expectancies and subjective response may be important in determining an individual's evaluation of alcohol's efficacy for pain self-management.
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Affiliation(s)
- Sharmagh Aghabeigi
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
| | - Nicholas J. Bush
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
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Lape EC, Powers JM, LaRowe LR, Ditre JW. Initial validation of the expectancies for Benzodiazepine Analgesia Scale. Exp Clin Psychopharmacol 2024; 32:369-378. [PMID: 38010761 PMCID: PMC11098706 DOI: 10.1037/pha0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Chronic pain populations exhibit greater prevalence of benzodiazepine (BZD) prescription (vs. the general population) and greater likelihood of BZD use not as prescribed and dependence symptoms. Individuals report taking BZDs for pain relief, potentially contributing to maintenance/escalation of BZD use and hazardous couse with prescription opioids. Identifying cognitive factors underlying pain-BZD use relations represents a critical step toward understanding the role of pain in BZD use trajectories. Outcome expectancies for substance-related analgesia have been implicated in pain-substance use comorbidity (e.g., alcohol), and there is reason to believe these processes may extend to BZD use. The present study aimed to examine psychometric properties of a newly adapted Expectancies for Benzodiazepine Analgesia (EBA) scale and probe associations between EBA scores and prescription opioid use behaviors. Participants were 306 adults (38.9% females) endorsing chronic pain and current BZD prescription who completed an online survey. Results provided initial support for psychometric validity of the EBA: evidence of single-factor structure with good model fit (Bollen-Stine bootstrap p = .101), excellent internal consistency (α = .93), and evidence of concurrent validity via correlations with pain variables, likelihood of BZD use not as prescribed, BZD dependence symptoms, and self-reported BZD use for pain relief. Exploratory findings among participants prescribed opioids indicated positive covariation between EBA scores and behaviors associated with higher risk opioid use. This is, to our knowledge, the first study to assess analgesia expectancies for BZD use. BZD analgesic expectancies warrant further study as a treatment target in comorbid pain and BZD use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Emma C. Lape
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
| | - Jessica M. Powers
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, 625 North Michigan Avenue, 21st Floor, Chicago, IL 60611, United States
| | - Lisa R. LaRowe
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244, United States
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Zaorska J, Skrzeszewski J, Kobyliński P, Trucco EM, Wojnar M, Kopera M, Jakubczyk A. From childhood trauma to alcohol use disorder severity - significance of depressive symptoms and expectations towards analgesic effects of alcohol. Alcohol Alcohol 2024; 59:agae041. [PMID: 38864292 DOI: 10.1093/alcalc/agae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
AIMS The objective of the current study was to describe and analyse associations between childhood emotional abuse, severity of depressive symptoms, and analgesic expectations of drinking in individuals with alcohol use disorder (AUD). METHODS A total of 240 individuals aged 43.85 ± 11.0 with severe AUD entering an inpatient, abstinence-based, and drug-free treatment program were assessed. The data on AUD severity, depressive symptoms, expectations towards the analgesic effects of alcohol and childhood emotional trauma was collected using questionnaire measures. The PROCESS SPSS macro for serial mediation with bootstrapping was used to test whether current severity of depressive symptoms and expectations towards analgesic effects of alcohol use serially mediated the association between childhood emotional abuse on AUD symptom severity. RESULTS There was evidence for two simple mediated effects, whereby the severity of depressive symptoms mediated the association between childhood emotional abuse on AUD symptom severity, and expectations towards analgesic effects of alcohol mediated the association between childhood emotional abuse on AUD symptom severity. There was also evidence to support serial mediation whereby both severity of depressive symptoms and expectations towards analgesic effects of alcohol mediated the association between childhood emotional abuse on AUD symptom severity. CONCLUSIONS It might be clinically relevant to address experiences of childhood emotional trauma, as well as individual expectations of analgesic effects of alcohol, in AUD treatment programs.
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Affiliation(s)
- Justyna Zaorska
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Jakub Skrzeszewski
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Paweł Kobyliński
- National Information Processing Institute, Laboratory of Interactive Technologies, al. Niepodległości 188B, 00-608 Warsaw, Poland
| | - Elisa Maria Trucco
- Department of Psychology, Florida International University, 11200 SW 8th Street, AHC 1 Miami, FL 33199, USA
- Center for Children and Families, Florida International University, 11200 SW 8th Street, AHC 1 Miami, FL 33199, USA
- Department of Psychiatry, Addiction Center, University of Michigan, 4250 Plymouth Road Ann Arbor, MI 48109, USA
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
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Alexander C, Bush NJ, Neubert JK, Robinson M, Boissoneault J. Expectancy of alcohol analgesia moderates perception of pain relief following acute alcohol intake. Exp Clin Psychopharmacol 2024; 32:228-235. [PMID: 37358545 PMCID: PMC10749982 DOI: 10.1037/pha0000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Although laboratory studies indicate alcohol reduces pain intensity and increases pain threshold, these effects likely do not completely explain perceived pain relief from alcohol intake. In this study, we tested expectancy of alcohol analgesia (EAA) as a moderator of subjective pain relief following oral alcohol challenge in individuals with and without chronic orofacial pain. Social drinkers (N = 48; 19 chronic pain; 29 pain-free controls) completed two testing sessions: alcohol administration (BrAC: 0.08 g/dL) and placebo. Alcohol expectancy (AE) was assessed using the EAA questionnaire and two 100-mm Visual Analogue Scales (VASs) regarding strength of belief that alcohol provides pain relief (AE VAS 1) or reduces pain sensitivity (AE VAS 2). Participants completed quantitative sensory testing (QST) involving application of pressure to the masseter insertion. Pain threshold (lbf; three repetitions) and pain intensity (4, 5, and 6 lbf; three repetitions each; 100-mm VAS) were collected. After each stimulus, participants rated perceived pain relief due to consumption of the study beverage (0-100 VAS). Higher EAA and AE VAS 1 ratings were associated with stronger perceived relief in the alcohol, but not placebo, condition. However, expectancy specifically related to reduction in pain sensitivity (AE VAS 2) was not associated with relief. Additionally, changes in pain threshold and intensity were not significantly correlated with perceived relief. Taken together, results suggest expectancy that alcohol provides pain relief is an important determinant of its negative reinforcing effects. Future studies should investigate challenging these expectancies as a means of reducing alcohol-related risk in people with pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Casey Alexander
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - Nicholas J. Bush
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - John K. Neubert
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Orthodontics, University of Florida, Gainesville, FL 32610
| | - Michael Robinson
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
| | - Jeff Boissoneault
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL 32610
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610
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Moskal D, Loughran TA, Funderburk JS, Scharer JL, Buckheit KA, Beehler GP. Pain and Hazardous Alcohol Use in Veterans in Primary Care: The Role of Affective Pain Interference and Alcohol Pain-Coping Perceptions. THE JOURNAL OF PAIN 2024; 25:682-689. [PMID: 37783381 DOI: 10.1016/j.jpain.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
Chronic pain and unhealthy alcohol use commonly co-occur and are associated with negative health outcomes. Veterans may be particularly vulnerable to these conditions, yet limited research has examined factors involved in their co-occurrence. This cross-sectional study aimed to examine the role of affective pain interference and alcohol pain-coping perceptions in the relationship between pain and hazardous alcohol use. As informed by the catastrophizing, anxiety, negative urgency, and expectancy model, we hypothesized that the relationship between pain and hazardous alcohol consumption is mediated by affective pain interference and stronger among those with greater perceptions that alcohol helps cope with pain. Participants were 254 VA primary care patients (87.8% male, Mage = 64.03, 76.4% White) with a history of chronic musculoskeletal pain, past-year alcohol use, and past-week pain. Veterans completed a mailed survey including measures of pain, affective pain interference, alcohol pain-coping perceptions, and hazardous alcohol use. Hypotheses were tested with regression models and PROCESS macros. As hypothesized, affective pain interference mediated the pain-hazardous alcohol use association. Contrary to hypotheses, results showed no moderating effect of alcohol pain-coping perceptions. Findings partially support relationships among theorized constructs and suggest that for Veterans with co-occurring pain and alcohol use it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain. PERSPECTIVE: This article presents a test of factors involved in the pain and alcohol relationship, as informed by the CANUE model. Findings suggest that for Veterans with co-occurring pain and past-year alcohol use, it may be important to target pain-related affective interference and perceptions that alcohol helps cope with pain.
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Affiliation(s)
- Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Travis A Loughran
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York; Department of Psychology, Syracuse University, Syracuse, New York; Department of Psychiatry, University of Rochester, Rochester, New York
| | - Jacob L Scharer
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Katherine A Buckheit
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York
| | - Gregory P Beehler
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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Parisi CE, Gracy HR, Bush NJ, Cook RL, Wang Y, Chichetto N. Does treating pain with alcohol affect drinking reduction among women with HIV enrolled in a clinical trial of naltrexone? ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1917-1925. [PMID: 37864537 PMCID: PMC10662960 DOI: 10.1111/acer.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/31/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Many women living with HIV (WLWH) experience pain. Alcohol use with the intent to treat pain could lead to hazardous drinking and difficulty in reducing drinking. Naltrexone acts on opioid receptors important for pain regulation and is an approved treatment for alcohol use disorder. In this secondary analysis of a randomized double-blind placebo-controlled naltrexone clinical trial, the goals were to (1) compare alcohol reduction between women who drank to treat pain and those who did not and (2) examine differences in alcohol reduction by both drinking intention and treatment arm. METHODS Women living with HIV (N = 194, mean age 48.3 years, 83% non-Hispanic Black, 11% Hispanic) with hazardous drinking (>7 drinks/week) were randomized to receive daily treatment with naltrexone 50 mg or placebo for 4 months. Study visits occurred at baseline and 2, 4, and 7 months (posttreatment). The number of drinks/week was measured using the Timeline Follow Back. Use of alcohol to treat pain was self-reported. Participants were categorized as using alcohol to treat pain or not and in the naltrexone or placebo group. Chi-square, t-test, MANOVA, and sequential mixed effects models were used to determine group differences in demographic factors, mean/drinks per week, and percent change in mean drinks/week at baseline and each follow-up visit. RESULTS There was a consistent decrease in drinking throughout the study. There was not a significant difference in mean drinks/week at any point in the study between women who used alcohol to treat pain and those who did not. When considering treatment arm, at 2 months only those who did not use alcohol to treat pain in the naltrexone group had a significantly lower mean drinks/week than the other groups (p = 0.007); all groups had similar decreases in drinking from 4 months onward. CONCLUSION In the naltrexone group, WLWH who drank to treat pain reduced their alcohol consumption more slowly than WLWH who did not drink to treat pain. Replication of these findings would suggest that alcohol treatment guidelines should address pain as a factor in drinking outcomes.
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Affiliation(s)
- Christina E. Parisi
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Hannah R. Gracy
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Nicholas J. Bush
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Yan Wang
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
| | - Natalie Chichetto
- Department of Epidemiology, University of Florida, Gainesville, FL
- Southern HIV and Alcohol Research Consortium, Emerging Pathogens Institute, University of Florida, Gainesville, FL
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