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Despite the long-standing belief in the analgesic properties of alcohol, experimental studies have produced mixed results. This meta-analysis aimed to clarify whether alcohol produces a decrease in experimentally-induced pain and to determine the magnitude of any such effect. PubMed, PsycINFO and Embase databases were searched from inception until 21/4/2016 for controlled studies examining the effect of quantified dosages of alcohol on pain response to noxious stimulation. Eighteen studies involving 404 participants were identified providing alcohol vs. no-alcohol comparisons for 13 tests of pain threshold (N=212) and 9 tests of pain intensity ratings (N=192). Random effects meta-analysis of standardized mean differences (SMD) provided robust support for analgesic effects of alcohol. A mean blood alcohol content (BAC) of approximately 0.08% (3-4 standard drinks) produced a small elevation of pain threshold (SMD=0.35[0.17, 0.54], p=.002), and a moderate-large reduction in pain intensity ratings, (SMD=0.64[0.37, 0.91], p<.0001), or equivalently, a mean reduction of 1.25 points on a 0-10 point pain rating scale. Furthermore, increasing BAC resulted in increasing analgesia, with each .02% BAC increment producing an increase of SMD=.11 for pain threshold and SMD=.20 for reduced pain intensity. Some evidence of publication bias emerged, but statistical correction methods suggested minimal impact on effect size. Taken together, findings suggest that alcohol is an effective analgesic that delivers clinically-relevant reductions in ratings of pain intensity, which could explain alcohol misuse in those with persistent pain despite its potential consequences for long-term health. Further research is needed to corroborate these findings for clinical pain states.
PERSPECTIVE: This meta-analysis provides robust evidence for the analgesic properties of alcohol, which could potentially contribute to alcohol misuse in pain patients. Strongest analgesia occurs for alcohol levels exceeding World Health Organisation guidelines for low-risk drinking and suggests raising awareness of alternative, less-harmful pain interventions to vulnerable patients may be beneficial.