Summary Chronic pain is a common, complex, and distressing problem that has a profound impact on individuals and society. It frequently presents as a result of a disease or an injury; however, it is not merely an accompanying symptom, but rather a separate condition in its own right, with its own medical definition and taxonomy. Studying the distribution and determinants of chronic pain allows us to understand and manage the problem at the individual and population levels. Targeted and appropriate prevention and management strategies need to take into account the biological, psychological, socio-demographic, and lifestyle determinants and outcomes of pain. We present a narrative review of the current understanding of these factors.

Chronic pain: a review of its epidemiology and associated factors in population-based studies

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations.

https://www.aerzteinitiative.at/alcohol11.pdf

Alcohol-use disorders

Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronic pain related to advanced medical illness is considered the standard of care in most of the world. In contrast, the long-term administration of an opioid for the treatment of chronic noncancer pain continues to be controversial. Concerns related to effectiveness, safety, and abuse liability have evolved over decades, sometimes driving a more restrictive perspective and sometimes leading to a greater willingness to endorse this treatment. The past several decades in the United States have been characterized by attitudes that have shifted repeatedly in response to clinical and epidemiological observations, and events in the legal and regulatory communities. The interface between the legitimate medical use of opioids to provide analgesia and the phenomena associated with abuse and addiction continues to challenge the clinical community, leading to uncertainty about the appropriate role of these drugs in the treatment of pain. This narrative review briefly describes the neurobiology of opioids and then focuses on the complex issues at this interface between analgesia and abuse, including terminology, clinical challenges, and the potential for new agents, such as buprenorphine, to influence practice.

Opioids and the treatment of chronic pain: controversies, current status, and future directions.

Stress generation in depression: A systematic review of the empirical literature and recommendations for future study.

Aims Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol.

Design  Longitudinal survey.

Setting, participants and measurement  Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury.

Findings  At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later.

Conclusions  The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Pain and use of alcohol to manage pain: prevalence and 3‐year outcomes among older problem and non‐problem drinkers

AIM: To examine reciprocal relations between stressors and drinking behavior among late-middle-aged and older women and men. DESIGN, SETTING, AND PARTICIPANTS: A community sample of 621 women and 941 men (mean age = 61) provided information about their life stressors and drinking behavior at three times: initial assessment, 1 year later and 4 years later. Structural equation modeling with manifest variables was used to examine cross-temporal relations between stressors and drinking behavior. FINDINGS: Stressors did not predict heavier or more frequent drinking. In fact, among women, increased health stressors predicted a reduction of alcohol consumption; among men, increased financial stressors suppressed alcohol consumption. Higher stressor levels in some life domains did foreshadow later drinking problems. More initial drinking problems resulted in more subsequent financial and spouse stressors for both women and men. Contrary to expectation, more frequent alcohol consumption presaged fewer negative life events, health stressors, and financial stressors for women, and fewer health stressors for men. CONCLUSIONS: The findings suggest that among older adults there may be a harmful feedback cycle whereby problematic drinking and life stressors exacerbate each other, but also a benign feedback cycle in which moderate alcohol consumption and life stressors reduce each other. Language: en

Reciprocal relations between stressors and drinking behavior: a three-wave panel study of late middle-aged and older women and men.

Objectives. We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.Methods. A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.Results. Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.Conclusion. Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.

/pdf/the-interplay-between-life-stressors-and-depressive-symptoms-3l7vpltowg.pdf

The Interplay Between Life Stressors and Depressive Symptoms Among Older Adults

Objective:The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors.Method:Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors.Results:Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined i...

/pdf/twenty-year-alcohol-consumption-and-drinking-problem-4mlswrjv11.pdf

Kathleen K. Schutte

Papers

Pain and use of alcohol to manage pain: prevalence and 3‐year outcomes among older problem and non‐problem drinkers

Reciprocal relations between stressors and drinking behavior: a three-wave panel study of late middle-aged and older women and men.

High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems

The Interplay Between Life Stressors and Depressive Symptoms Among Older Adults

Twenty-year alcohol-consumption and drinking-problem trajectories of older men and women.