Exploring the Complex Relationship Between Pain and Alcohol Use

Pain and alcohol are deeply intertwined in ways that are often misunderstood, by patients, clinicians, and even researchers. While alcohol is commonly viewed as a quick way to dull pain, its effects are complex and can contribute to long-term health risks when pain and drinking reinforce one another. At the University of Minnesota, the Minnesota Alcohol and Pain Lab (MAPL) is working to untangle this relationship, using innovative and interdisciplinary research to better understand how pain and alcohol interact and how that knowledge can improve patient care.

Led by Jeff Boissoneault, PhD, MAPL focuses on understanding the biological, psychological, and behavioral mechanisms that link alcohol use and pain. “Most of our studies address the intersection between alcohol use and pain in some way,” Dr. Boissoneault explains. “We do a lot of work about the acute pain relieving effects of drinking using behavioral pain testing and functional brain imaging, and also have an NIH-funded study about how pain affects drinking in people with chronic jaw pain both in the laboratory and in daily life. Our lab also works to try to improve methods to measure alcohol use, model clinical decision making about pain and substance use treatment, and improve understanding of how pain is processed in the brain and spinal cord.”

Dr. Boissoneault’s interest in this overlap grew out of earlier work examining alcohol’s effects on cognition and behavior. During his postdoctoral training, he began to see important parallels between the neural systems involved in pain and those involved in alcohol use. “During that fellowship, I realized there was a lot of commonality in the brain regions and networks that drive both drinking and pain, but there were few labs really studying that overlap,” he says. “That's been the focus of my work since then.”

In May 2023, Dr. Boissoneault joined the University of Minnesota Department of Anesthesiology after eight years as a faculty member at the University of Florida and established MAPL to expand this work in a collaborative environment. “I started MAPL to continue building on our work and form new collaborations with other researchers across the U who were also interested in pain and addiction,” he notes.

Although many people assume alcohol is an effective pain reliever, MAPL’s research highlights how much remains unknown about this interaction. “It may seem obvious that alcohol relieves pain, or that pain may drive people to drink alcohol,” Dr. Boissoneault says. “But there's actually a lot we don't yet know about how alcohol and pain interact.” While alcohol can lead to modest reductions in pain sensitivity, subjective experiences often tell a different story. “People tend to report much greater perceived relief than would be expected from these fairly small objective effects,” he adds. “I suspect that feeling of relief is what motivates people to drink when they're in pain, so that's a major focus of the lab right now.”

Graduate Research Assistant Aishwarya Belhe sees this relationship as both clinically and societally significant. “Pain self-management using alternative substances like alcohol is pretty common and this may drive people in pain to drink more alcohol,” she says. “There's a lot we don't know about what factors contribute to this bidirectional relationship between alcohol and pain, highlighting the importance of the study of alcohol use in the context of pain.”

This work has important implications for clinical practice, particularly in pain management and substance use treatment settings. According to Dr. Boissoneault, alcohol use is more common among pain patients than many clinicians realize. “Clinicians should be aware that a substantial number of their patients (~25% in some studies) may use alcohol to help self-manage their pain, which can actually make pain worse in the long run and also lead to alcohol-related consequences,” he says. Integrating alcohol use assessments into pain care, and pain management strategies into alcohol treatment, could help address these risks more effectively.

Aishwarya emphasizes that limitations in current pain treatments can unintentionally push patients toward alcohol. “The current pain treatments available have relatively poor efficacy, significant undesired consequences and rarely meet patients' own criteria for relief,” she says. “This incentivizes pain patients to use alcohol, leading to alcohol-related negative consequences and in the long run, worsening of their pain.”

The lab’s growing impact was underscored in September 2024, when the lab received a five-year R01 grant from the National Institute on Alcohol Abuse and Alcoholism. “One of the lab's biggest accomplishments to date was being awarded a 5-year R01 grant to study the effect of pain on drinking in people with chronic orofacial pain,” Dr. Boissoneault says. “We're very grateful for that support!”

In addition to this work, the lab is expanding into new collaborative and translational directions, including reverse-translation studies that examine alcohol–pain interactions in rodent models. “We are starting some exciting new collaborations with colleagues in the Departments of Anesthesiology, Neuroscience, and Pharmacology to ‘reverse translate’ our work on the effect of pain on drinking to rodent models so we can really understand how their interaction changes over time,” Dr. Boissoneault explains. MAPL is also collaborating with the Department of Psychiatry to study how chronic heavy alcohol use can lead to painful peripheral neuropathy.

For graduate students like Aishwarya, MAPL offers a unique opportunity to bridge preclinical and human research. “After joining this lab and leading the project of looking at alcohol drinking behavior changes in mice and relating that to the lab's human work has given me a newfound appreciation for the interplay between pain, substance use and the affective components of pain,” she says. She describes the challenge of translating pain measures across species as deeply rewarding, “getting to work in both of these models and taking steps toward bridging the gap between them has been truly rewarding.”

By integrating neuroscience, behavioral science, and clinical insight, the Minnesota Alcohol and Pain Lab is advancing a more nuanced understanding of pain and alcohol use, work that has the potential to shape future research, inform clinical practice, and ultimately improve outcomes for patients living with pain.