Chronic pain (CP) and alcohol use disorder (AUD) frequently co-occur, yet the psychological factors underlying their interaction remain unclear. Intolerance of uncertainty (IU) - a cognitive trait linked to distress in unpredictable situations - may influence pain management and coping behaviors in these populations. This study examined whether IU moderates pain and alcohol craving responses to a pain-related stressor in individuals with CP and AUD. Fifty-five adults aged 18-65 years were enrolled, including individuals with CP only (n=20), AUD only (n=14), CP+AUD (n=8), and healthy controls (n=13). Participants completed a self-report measure of IU and the Yale Pain Stress Test (YPST), an adaptation of the Cold Pressor Test, designed to elicit pain-related stress. Behavioral pain tolerance, subjective pain and alcohol craving were assessed across two experimental sessions, one with exposure to an ice-cold water stressor and the second with a warm-water control condition. Exposure to the pain-related stressor significantly reduced behavioral pain tolerance and increased subjective pain across all groups, and also heightened alcohol craving, particularly in individuals with AUD. IU moderated the pain experience during pain-related stress: in the CP+AUD group, higher IU was associated with lower pain tolerance, whereas in the AUD group, higher IU was correlated with greater pain tolerance. IU also moderated craving responses, with higher IU predicting increased craving in individuals with both CP and AUD. These preliminary findings highlight IU as a potential treatment target, suggesting that interventions aimed at improving uncertainty tolerance may enhance pain coping and reduce stress-driven alcohol-seeking behaviors in vulnerable populations.

Keywords: Chronic pain; alcohol craving; alcohol use disorder; cold-pressor test; intolerance of uncertainty; pain tolerance; stress.

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慢性疼痛（CP）和酒精使用障碍（AUD）常常同时出现，但它们相互作用的心理因素仍然不清楚。不确定性容忍度（IU）——一种在不可预测的情况下与痛苦相关的认知特质——可能会影响这些人群中的疼痛管理和应对行为。本研究考察了IU是否调节CP和AUD患者在面对与疼痛有关的压力源时的疼痛和酒精渴望反应。共招募了55名18至65岁的成人，包括仅患有慢性疼痛的人（n=20），仅患有酒精使用障碍的人（n=14），同时患有CP和AUD的人（n=8）以及健康对照组（n=13）。参与者完成了IU的自评量表，并进行了耶鲁疼痛压力测试（YPST），这是冷压器试验的一种改编版本，旨在引发与疼痛相关的压力。在两个实验会话中评估了行为疼痛耐受性、主观疼痛和酒精渴望，其中一个会话暴露于冰冷的水压力源，另一个则为温暖的水控制条件。对疼痛相关压力源的暴露显著降低了所有组别的行为疼痛耐受性和增加了主观疼痛，并且尤其提高了患有AUD个体的酒精渴望。IU调节了在与疼痛相关的压力期间的疼痛体验：在CP+AUD组中，较高的IU与较低的疼痛容忍度有关，而在仅患有AUD的组别中，较高的IU则与较高的疼痛容忍度相关联。IU还调节了渴望反应，在同时患有CP和AUD的人群中，较高的IU预测了增加的渴望。这些初步研究结果突显了IU作为潜在治疗目标的重要性，表明旨在提高不确定性容忍度的干预措施可以增强疼痛应对能力，并减少易感人群中的压力驱动型酒精寻求行为。

关键词：
慢性疼痛；酒精渴望；酒精使用障碍；冷压器测试；不确定性的容忍度；疼痛耐受性；压力。