Intersection of alcohol use, pain symptoms, and negative affect in total knee arthroplasty patients and people with HIV

Alcohol is a well-known analgesic, although excessive alcohol use can lead to hyperalgesia and heightened negative affect. This cross-sectional study examined associations between alcohol use, self-reported pain, and negative affective symptoms in two distinct cohorts of patients vulnerable to chronic pain: individuals undergoing total knee arthroplasty (TKA) surgery and a cohort of people with HIV (PWH). Participants were enrolled in two clinical studies: a retrospective study of patients undergoing TKA and a longitudinal study of PWH, the New Orleans Alcohol Use in HIV (NOAH) cohort. Based on the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) score, participants in both cohorts were stratified as alcohol drinkers (AUDIT-C ≥ 1) or non-drinkers (AUDIT-C < 1). In the NOAH cohort, pain intensity and interference were assessed using the 36-Item Short Form Survey (SF-36). In the TKA cohort, self-reported pain was quantified using the Pain Intensity and Pain Interference items from the Patient-Reported Outcomes Measurement Information System® (PROMIS-29) and the Knee Osteoarthritis and Outcomes Score (KOOS) Pain scores. Alcohol drinkers reported fewer pain symptoms compared to non-drinkers across both cohorts, and females with HIV reported more pain compared to males with HIV. Furthermore, pain symptoms were associated with increased anxiety and depression symptoms in both cohorts, and in PWH these associations appeared stronger in drinkers compared to non-drinkers. These findings suggest that although alcohol may offer some analgesic benefits, patients should be cautioned about its use for self-medication, as it may increase risk for pain-related negative affective comorbidities. PERSPECTIVE: Alcohol can both relieve and exacerbate pain. The current study discovered that ongoing alcohol use was associated with fewer self-reported pain symptoms but appeared to increase associations between pain and negative affective symptoms in two vulnerable cohorts. Findings support cautioning patients against the recurring use of alcohol for pain management.