title: Approach to the pharmacological management of chronic pain in patients with an alcohol use disorder.
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.
authors.affiliation: University Health Network, Toronto, ON, Canada ; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Murphy
authors.affiliation: University Health Network, Toronto, ON, Canada.
authors.forename: Karen Wk
authors.initials: KW
authors.lastname: Ng
authors.affiliation: St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver, BC, Canada.
authors.forename: Victoria Ch
authors.initials: VCh
authors.lastname: Su
authors.affiliation: Windsor Regional Hospital, Windsor, ON, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Woodworth-Giroux
authors.affiliation: University Health Network, Toronto, ON, Canada.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Levy
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada ; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Sproule
authors.affiliation: University Health Network, Toronto, ON, Canada ; Institute for Work and Health, Toronto, ON, Canada.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
keywords: alcohol use disorder; chronic pain; opioids