# Bi-directional associations between alcohol consumption and pain among non-manual workers: a random-intercept cross-lagged panel analysis in the British Whitehall II cohort study

## TL;DR

This study finds that higher alcohol consumption is linked to increased pain severity in non-manual workers, especially among midlife retirees and those with lower socioeconomic status.

## Contribution

The study provides novel evidence of bidirectional associations between alcohol consumption and pain severity in non-manual workers using longitudinal data.

## Key findings

- Elevated alcohol consumption was associated with increased pain severity, particularly among midlife retirees.
- Pain severity was linked to alcohol consumption at earlier intervals but the association weakened over time.
- Low socioeconomic position individuals showed a stronger alcohol-to-pain association.

## Abstract

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.

This study examined bidirectional associations between alcohol and pain among non-manual workers. Within-person increases in alcohol consumption were associated with subsequent pain severity, particularly among midlife retirees and low-SEP individuals. Positive pain-to-alcohol associations were observed among retirees but attenuated over time.