Alcohol intake and pain in British Civil Servants: the modulating role of socioeconomic position

Abstract Background Socioeconomic position (SEP) is associated with both alcohol use and pain; however, its role in the potential relationship between alcohol intake and pain remains understudied. This study investigated how SEP modulates the association between alcohol use and pain. Methods We analyzed data from phases 7, 9, and 12 (2002-2015, response rates 72%, 72%, and 67%) of the British Whitehall II cohort study. Average alcohol consumption and problematic use were assessed through self-reported intake converted to pure alcohol units (1 unit = 8g pure alcohol) and four-item questionnaires on alcohol dependency. SEP was determined by civil service employment grade (low, middle, high). Pain severity was measured by weighted sum score of pain-site number and RAND-36 bodily pain severity (categorized into none, mild, and severe). Random-intercept cross-lagged panel models assessed associations between alcohol consumption and pain severity, with marginal effects calculated for standardized latent response variables. Results Of 6,967 participants enrolled, 5,928 participants (10.4% low SEP, 43.1% middle SEP, 46.5% high SEP) completed the essential questionnaires. Low-SEP and high-SEP participants with higher prior pure-alcohol consumption were more likely to experience subsequent severe pain (high SEP: β = 0.08, 95% CI: [0.02, 0.019]; low SEP: β = 0.07, 95% CI: [0.01, 0.013]), corresponding to 28.3% (95% CI: 3.9-56.1%) and 33.1% (95% CI: 3.8-61.9%) increased likelihood of severe pain among low-SEP and high-SEP participants. Low-SEP participants with prior pain showed increased pure-alcohol consumption in the subsequent phase (β = 0.03, 95% CI: [-0.01, 0.06]), though this finding was not statistically significant. Conclusions We recommend integrating alcohol use screening into pain management protocols for non-manual workers with low- and high-SEP. Low-SEP workers do not appear to use alcohol as a pain-coping strategy. Key messages • Higher socioeconomic position may not protect non-manual workers from the risk of severe pain associated with problematic alcohol use. • Alcohol use monitoring for workers in low socioeconomic position may help reduce the risk of developing severe pain.