Alcohol Consumption and Associations With Short- and Long-Term Outcomes in Low Back Pain: A Longitudinal Case-Crossover Study.

BACKGROUND

The study objectives were to examine associations between participant-reported alcohol consumption and (1) flares of low back pain (LBP) and (2) pain intensity at 1-year follow-up.

METHODS

This longitudinal case-crossover study nested in a cohort included 474 participants with LBP who completed up to 36 scheduled assessments and additional patient-initiated assessments (triggered by the onset of new flares) over a 1-year period. Each assessment asked participants to report whether a LBP flare was present using a validated definition. Conditional logistic regression was used to estimate associations between alcohol consumption and subsequent flares. Linear regression was used to estimate associations between baseline alcohol consumption and LBP intensity at 1-year follow-up.

RESULTS

In analyses of 10,251 assessments over 1 year, each additional drink in the past 24 h was associated with a slightly lower odds of subsequent LBP flares (odds ratio [OR] per drink 0.95, 95% CI: 0.90, 0.997). Each additional average number of drinks in the past 24 h at baseline was significantly associated with slightly lower LBP intensity 1 year later (-0.19 Numerical Rating Scale (NRS) points [95% CI: -0.38, -0.004]). However, this association was diminished and nonsignificant after adjusting for the number of drinks in the past 24 h at the 1-year follow-up assessment.

CONCLUSIONS

This study suggests a small, transient protective association of alcohol with LBP flares in the immediate-term, but no clinically meaningful beneficial associations with pain in the long-term. The findings do not support alcohol use as a pain management strategy.

SIGNIFICANCE STATEMENT: This epidemiologic study did not find meaningful associations between alcohol consumption and low back pain intensity in the long-term, although a small-magnitude, transient association with lower risk of subsequent flares of low back pain was observed. These findings bridge gaps in the evidence between laboratory studies of acute analgesic effects of alcohol on pain perception and cohort studies examining long-term low back pain outcomes.