A Triple Threat: Alcohol Use Disorders in the Presence of Comorbid Chronic Pain Conditions and Depressive Disorders in the Collaborative Psychiatric Epidemiology Surveys, 2001-2003
Background: Frequently patients with chronic pain conditions have comorbid depressive disorders. The relationship between the diagnoses is often bidirectional, with the effects of one condition exacerbating the effects of the other. Alcohol use disorders (AUD) are also independently associated with both conditions. This study aims to determine the prevalence of alcohol use disorders among patients with comorbid chronic pain conditions and depressive disorders in a nationally representative sample of US adults and ascertain the characteristics of patients with all three diagnoses.
Methods: This cross-sectional analysis utilizes data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003. The sample includes respondents who reported having a chronic pain condition during their lifetime. The outcome is a dichotomous measure of past 12 month AUD, meeting DSM-IV criteria. The exposure is represented as a categorical variable with four groups: no depressive disorder(s) or chronic pain conditions during past year, at least one depressive disorder but no chronic pain conditions during the past year, at least one chronic pain condition during the past year but no depressive disorders during the past year, at least one depressive disorder and at least one chronic pain condition during the past year. Models determining prevalence and patient characteristics were obtained using logistic regression. All analyses account for complex survey design effects.
Preliminary Results: Results show an elevated association between having a comorbid chronic pain condition and a depressive disorder and an AUD during the past 12 months, POR=1.914 (0.394, 9.573). This association is not present for the other exposure categories: past year chronic pain but no depressive disorder and past year depressive disorder but no chronic pain. Subsequent models concur after adjusting for potential confounding variables. The prevalence of past year comorbid chronic pain conditions and depressive disorders is 10.93% (SE=0.6931), among adults reporting any chronic pain condition during their lifetime. The prevalence of AUD among adults with comorbid chronic pain and depression is 3.82% (SE=1.132).
Discussion: This analysis provides empirical support for the association between psychiatric illness and chronic pain. An association between AUD and comorbid chronic pain and depression signals a need for clinicians to conduct additional screening for AUD when evaluating treatment plans and diagnostic recommendations among adults receiving treatment for chronic pain and depression
