Background: Measurement of ethanol (EtOH) use in chronic pain patients has always been a challenge. Current biomarkers are easily confounded, giving unreliable results. Self-reporting is unreliable. Phosphatidylethanol (PEth) is a recent EtOH biomarker that shows promise as an alternative measure of EtOH. Methods: Twenty patients were included in this study. All were 21 years of age or older and had chronic pain for greater than 3 months. Patients took the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Blood was collected for PEth testing. Correlation between Audit score (0 - 40) and PEth level (ng/mL) was done with the Pearson Product-moment correlation coefficient (SPSS). Values are means ± S.E.M. Significance at p ≤ 0.05. Opioid use with EtOH use was also examined. Results: Twenty patients were enrolled, 17 (85%) males and 3 (15%) females. AUDIT scores were 8.1 ± 1.4. PEth levels were 178.3 ± 43.5. Eighty-five percent of patients had Audit scores indicating mild to moderate use of EtOH while 15% had severe use. PEth levels indicated 70% mild to moderate EtOH use and 30% heavy use. The correlation coefficient between the Audit score and PEth was 0.219 (p = 0.353) and not significant. Twenty-five percent of patients in the study were on opioids. The average PEth level in these patients was 273 ± 101.7. Conclusions: There is a poor correlation between self-reporting of EtOH use per AUDIT and PEth levels. Twenty-five percent of patients in the study were also on opioids, with PEth levels indicating high levels of EtOH consumption in this group. This suggests that self-reporting of EtOH use is inadequate in the chronic pain setting to detect actual EtOH use.
References
[1]
Tori, M.E., Larochelle, M.R. and Naimi, T.S. (2020) Alcohol or Benzodiazepine Co-Involvement with Opioid Overdose Deaths in the United States, 1999-2017. JAMA Network Open, 3, e202361. https://doi.org/10.1001/jamanetworkopen.2020.2361
[2]
Weathermon, R. and Crabb, D.W. (1999) Alcohol and Medication Interactions. Alcohol Research & Health, 23, 40-54.
[3]
Hahn, J.A., Anton, R.F. and Javors, M.A. (2016) The Formation, Elimination, Interpretation, and Future Research Needs of Phosphatidylethanol for Research Studies and Clinical Practice. Alcoholism: Clinical and Experimental Research, 40, 2292-2295. https://doi.org/10.1111/acer.13213
[4]
Luginbühl, M., Wurst, F.M., Stöth, F., Weinmann, W., Stove, C.P. and Van Uytfanghe, K. (2022) Consensus for the Use of the Alcohol Biomarker Phosphatidylethanol (Peth) for the Assessment of Abstinence and Alcohol Consumption in Clinical and Forensic Practice (2022 Consensus of Basel). Drug Testing and Analysis, 14, 1800-1802. https://doi.org/10.1002/dta.3340
[5]
Selim, R., Zhou, Y., Rupp, L.B., Trudeau, S., Naffouj, S., Shamaa, O., et al. (2022) Availability of Peth Testing Is Associated with Reduced Eligibility for Liver Transplant among Patients with Alcohol-Related Liver Disease. Clinical Transplantation, 36, e14595. https://doi.org/10.1111/ctr.14595
[6]
Novak, L., Soravia, L.M., Bünter, A., Stöth, F., Wopfner, A., Weinmann, W., et al. (2023) Alcohol Biomarker Phosphatidylethanol as a Predictor of the Severity of Alcohol Withdrawal Syndrome. Alcohol and Alcoholism, 58, 198-202. https://doi.org/10.1093/alcalc/agac071
[7]
Reisfield, G.M., Teitelbaum, S.A., Opie, S.O., Jones, J., Morrison, D.G. and Lewis, B. (2020) The Roles of Phosphatidylethanol, Ethyl Glucuronide, and Ethyl Sulfate in Identifying Alcohol Consumption among Participants in Professionals Health Programs. Drug Testing and Analysis, 12, 1102-1108. https://doi.org/10.1002/dta.2809
[8]
Riley, J.L. and King, C. (2009) Self-Report of Alcohol Use for Pain in a Multi-Ethnic Community Sample. The Journal of Pain, 10, 944-952. https://doi.org/10.1016/j.jpain.2009.03.005
[9]
Zale, E.L., Maisto, S.A. and Ditre, J.W. (2015) Interrelations between Pain and Alcohol: An Integrative Review. Clinical Psychology Review, 37, 57-71. https://doi.org/10.1016/j.cpr.2015.02.005
[10]
Witkiewitz, K. and Vowles, K.E. (2018) Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcoholism: Clinical and Experimental Research, 42, 478-488. https://doi.org/10.1111/acer.13594
[11]
Reinert, D.F. and Allen, J.P. (2007) The Alcohol Use Disorders Identification Test: An Update of Research Findings. Alcoholism: Clinical and Experimental Research, 31, 185-199. https://doi.org/10.1111/j.1530-0277.2006.00295.x
[12]
Midanik, L.T. (1989) Perspectives on the Validity of Self-Reported Alcohol Use. British Journal of Addiction, 84, 1419-1423. https://doi.org/10.1111/j.1360-0443.1989.tb03920.x
[13]
Jones, J., Jones, M., Plate, C. and Lewis, D. (2011) The Detection of 1-Palmitoyl-2-Oleoyl-Sn-Glycero-3-Phosphoethanol in Human Dried Blood Spots. Analytical Methods, 3, 1101-1106. https://doi.org/10.1039/c0ay00636j
[14]
Neumann, T., Neuner, B., Gentilello, L.M., Weiss-Gerlach, E., Mentz, H., Rettig, J.S., et al. (2004) Gender Differences in the Performance of a Computerized Version of the Alcohol Use Disorders Identification Test in Subcritically Injured Patients Who Are Admitted to the Emergency Department. Alcoholism: Clinical and Experimental Research, 28, 1693-1701. https://doi.org/10.1097/01.alc.0000145696.58084.08
[15]
Gladden, R.M., O’Donnell, J., Mattson, C.L. and Seth, P. (2019) Changes in Opioid-Involved Overdose Deaths by Opioid Type and Presence of Benzodiazepines, Cocaine, and Methamphetamine—25 States, July December 2017 to January June 2018. Morbidity and Mortality Weekly Report, 68, 737-744. https://doi.org/10.15585/mmwr.mm6834a2
[16]
Hannuksela, M.L., Liisanantti, M.K., Nissinen, A.E.T. and Savolainen, M.J. (2007) Biochemical Markers of Alcoholism. Clinical Chemical Laboratory Medicine, 45, 953-961. https://doi.org/10.1515/cclm.2007.190
[17]
Harris, J.C., Leggio, L. and Farokhnia, M. (2021) Blood Biomarkers of Alcohol Use: A Scoping Review. Current Addiction Reports, 8, 500-508. https://doi.org/10.1007/s40429-021-00402-7
[18]
Andresen-Streichert, H., Müller, A., Glahn, A., Skopp, G. and Sterneck, M. (2018) Alcohol Biomarkers in Clinical and Forensic Contexts. Deutsches Ärzteblatt International, 115, 309-315. https://doi.org/10.3238/arztebl.2018.0309
[19]
Erol, A. and Karpyak, V.M. (2015) Sex and Gender-Related Differences in Alcohol Use and Its Consequences: Contemporary Knowledge and Future Research Considerations. Drug and Alcohol Dependence, 156, 1-13. https://doi.org/10.1016/j.drugalcdep.2015.08.023
[20]
Perilli, M., Toselli, F., Franceschetto, L., Cinquetti, A., Ceretta, A., Cecchetto, G., etal. (2023) Phosphatidylethanol (Peth) in Blood as a Marker of Unhealthy Alcohol Use: A Systematic Review with Novel Molecular Insights. International Journal of Molecular Sciences, 24, Article 12175. https://doi.org/10.3390/ijms241512175
[21]
Aradottir, S. (2004) Phosphatidylethanol Formation and Degradation in Human and Rat Blood. Alcohol and Alcoholism, 39, 8-13. https://doi.org/10.1093/alcalc/agh003