Approach to the pharmacological management of chronic pain in patients with an alcohol use disorder

Abstract

Laura Murphy,1,2 Karen WK Ng,1 Victoria CH Su,3 Sarah Woodworth-Giroux,4 Todd S Levy,1 Beth A Sproule,2,5 Andrea D Furlan1,6 1University Health Network, Toronto, ON, Canada; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; 3St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver, BC, Canada; 4Windsor Regional Hospital, Windsor, ON, Canada; 5Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; 6Institute for Work and Health, Toronto, ON, Canada Abstract: This paper provides an overview of research, guidelines, and clinical considerations for the use of medications for chronic pain in the management of patients with an alcohol use disorder. A review of the literature identified randomized controlled trials, epidemiological cohort studies, consensus guidelines, and one systematic review and meta-analysis. Where gaps in the literature existed, clinical experience of the authors is included. Use of nonopioid medications should be given priority and may offer a more favorable risk profile as well as benefits beyond pain management, such as improvement in anxiety, depression, or insomnia. Pregabalin and gabapentin have additional benefits to decrease alcohol cravings or time to relapse after a period of abstinence from alcohol. Drug interactions between selected analgesics and alcohol, disulfiram, or naltrexone require careful consideration. Keywords: chronic pain, alcohol use disorder, opioids