Analgesic effects of alcohol: A systematic review and meta-analysis of controlled experimental studies in healthy participants

Trevor Thompson; Charlotte Oram; Christoph U Correll; Stella Tsermentseli; Brendon Stubbs

doi:10.1016/j.jpain.2016.11.009

Analgesic effects of alcohol: A systematic review and meta-analysis of controlled experimental studies in healthy participants

Trevor Thompson, Charlotte Oram, Christoph U Correll, Stella Tsermentseli, Brendon Stubbs

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Abstract

Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO and Embase databases were searched from inception until 21/4/2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol vs. no-alcohol comparisons for 13 tests of pain threshold (N=212) and 9 tests of pain intensity ratings (N=192). Random effects meta-analysis of standardized mean differences (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately 0.08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD=0.35[0.17, 0.54], p=.002), and a moderate-large reduction in pain intensity ratings, (SMD=0.64[0.37, 0.91], p<.0001), or equivalently, a mean reduction of 1.25 points on a 0-10 point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD=.11 for pain threshold and SMD=.20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states.

PERSPECTIVE: This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organisation guidelines for low-risk drinking and suggests raising awareness of alternative, less-harmful pain interventions to vulnerable patients may be beneficial.

Original language	English
Journal	JOURNAL OF PAIN
Early online date	2 Dec 2016
DOIs	https://doi.org/10.1016/j.jpain.2016.11.009
Publication status	E-pub ahead of print - 2 Dec 2016

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10.1016/j.jpain.2016.11.009

Analgesic effects of alcohol_THOMPSON_Accepted14November2016_GREEN AAMAccepted author manuscript, 3.62 MBLicence: CC BY-NC-ND

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@article{17e7c842951243adb03ac562021b2ae2,

title = "Analgesic effects of alcohol: A systematic review and meta-analysis of controlled experimental studies in healthy participants",

abstract = "Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO and Embase databases were searched from inception until 21/4/2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol vs. no-alcohol comparisons for 13 tests of pain threshold (N=212) and 9 tests of pain intensity ratings (N=192). Random effects meta-analysis of standardized mean differences (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately 0.08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD=0.35[0.17, 0.54], p=.002), and a moderate-large reduction in pain intensity ratings, (SMD=0.64[0.37, 0.91], p<.0001), or equivalently, a mean reduction of 1.25 points on a 0-10 point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD=.11 for pain threshold and SMD=.20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states.PERSPECTIVE: This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organisation guidelines for low-risk drinking and suggests raising awareness of alternative, less-harmful pain interventions to vulnerable patients may be beneficial.",

author = "Trevor Thompson and Charlotte Oram and Correll, {Christoph U} and Stella Tsermentseli and Brendon Stubbs",

note = "Copyright {\^A}{\textcopyright} 2016. Published by Elsevier Inc.",

year = "2016",

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AU - Oram, Charlotte

AU - Correll, Christoph U

AU - Tsermentseli, Stella

AU - Stubbs, Brendon

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N2 - Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO and Embase databases were searched from inception until 21/4/2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol vs. no-alcohol comparisons for 13 tests of pain threshold (N=212) and 9 tests of pain intensity ratings (N=192). Random effects meta-analysis of standardized mean differences (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately 0.08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD=0.35[0.17, 0.54], p=.002), and a moderate-large reduction in pain intensity ratings, (SMD=0.64[0.37, 0.91], p<.0001), or equivalently, a mean reduction of 1.25 points on a 0-10 point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD=.11 for pain threshold and SMD=.20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states.PERSPECTIVE: This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organisation guidelines for low-risk drinking and suggests raising awareness of alternative, less-harmful pain interventions to vulnerable patients may be beneficial.

AB - Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO and Embase databases were searched from inception until 21/4/2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol vs. no-alcohol comparisons for 13 tests of pain threshold (N=212) and 9 tests of pain intensity ratings (N=192). Random effects meta-analysis of standardized mean differences (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately 0.08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD=0.35[0.17, 0.54], p=.002), and a moderate-large reduction in pain intensity ratings, (SMD=0.64[0.37, 0.91], p<.0001), or equivalently, a mean reduction of 1.25 points on a 0-10 point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD=.11 for pain threshold and SMD=.20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states.PERSPECTIVE: This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organisation guidelines for low-risk drinking and suggests raising awareness of alternative, less-harmful pain interventions to vulnerable patients may be beneficial.

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DO - 10.1016/j.jpain.2016.11.009

M3 - Article

C2 - 27919773

SN - 1526-5900

JO - JOURNAL OF PAIN

JF - JOURNAL OF PAIN

ER -

Analgesic effects of alcohol: A systematic review and meta-analysis of controlled experimental studies in healthy participants

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