Bi-directional associations between alcohol consumption and pain among non-manual workers: a random-intercept...

The direction and temporality of the association between alcohol use and pain remain understudied among non-manual workers. This study investigated bidirectional associations between alcohol consumption and pain among current and retired non-manual workers, with exploratory subgroup analyses by retirement transition status, retirement age, and socioeconomic position (SEP).

Survey data from Phases 7, 9, and 12 (2002-15) of the Whitehall II cohort study were analyzed (n = 5928, baseline mean age 60.7 years, 71% men). Alcohol consumption was assessed through self-reported intake converted to pure alcohol units. Pain severity was derived from musculoskeletal pain-site number and RAND-36 bodily pain measures, categorized as none, mild, or moderate/severe. Random-intercept cross-lagged panel models without equality constraints estimated within-person associations, with subgroup analyses by retirement transition and SEP.

At baseline, 23.1% reported above-moderate pain severity and 30.0% exceeded recommended limits (>14 units/week). During 14-year follow-up, 47.3% remained retired, 10.1% were employed, and 40.1% transitioned from employment to retirement. Elevated alcohol consumption was associated with increased pain severity among all participants (βP7 → P9 = 0.07, 95% confidence interval [CI]: 0.02-0.12; βP9 → P12 = 0.04, 95% CI: 0.00-0.08), with stronger effect among midlife retirees (βP9→P12 = 0.15, 95% CI: 0.04-0.25) and low-SEP participants (βP9→P12 = 0.22, 95% CI: 0.04-0.51). Pain was associated with alcohol consumption at earlier intervals, but associations attenuated subsequently.

Elevated alcohol consumption might be associated with increased pain severity among non-manual workers, particularly midlife retirees and low-SEP individuals. Pain-to-alcohol associations were observed but were inconsistent across intervals.