Does Pain Drive Substance Use in Cancer Patients?

TOPLINE:

Cancer survivors experiencing pain show greater likelihood of using tobacco and cannabis, whereas being less likely to consume alcohol. Pain intensity and chronic pain status are independently associated with increased fatigue, sleep difficulties, poorer mental health, and lower health-related quality of life.

METHODOLOGY:

• Pain is common among cancer survivors, with approximately 30% meeting criteria for chronic pain, and rates up to 50% among those with advanced disease.
• Previous research often focused on individuals with chronic noncancer pain, excluding those with cancer-related pain. Most existing studies examined single substances rather than multiple substances, limiting comparison of associations across different substances.
• Analysis included two national datasets: Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study with 1252 adults (88% White individuals; 55% women; 60% aged > 65 years) and the 2020 National Health Interview Survey (NHIS) with 4130 adults (83% White individuals; 56% women; mean age, 66 years) who reported lifetime cancer diagnosis.
• Researchers examined past-week pain intensity in PATH Study and chronic pain status in NHIS, analyzing their associations with cigarette, e-cigarette, cannabis, and alcohol use through regression analyses.
• Outcome measures included substance use patterns, fatigue, sleep difficulties, emotional distress, mental health, physical health, and health-related quality of life.

TAKEAWAY:

• Past-week pain intensity was associated with greater odds of cigarette smoking (adjusted odds ratio [AOR], 1.34; 95% CI, 1.26-1.42; P P = .003), and cannabis use (AOR, 1.17; 95% CI, 1.09-1.26; P
• Cancer survivors with chronic pain showed higher likelihood of cigarette smoking (AOR, 1.65; 95% CI, 1.25-2.18; P P
• Both pain and cigarette smoking were independently linked to greater fatigue, sleep difficulties, poorer mental health, and lower health-related quality of life (P
• Cannabis use was associated with lower self-perception of mental health (P = .002), whereas alcohol use correlated with better perceived overall health and greater health-related quality of life (P = .004).

IN PRACTICE:

“Given that substance use may impact cancer treatment and its side effects and contribute to pain chronification, there is an urgent need to develop tailored interventions for co-occurring pain and substance use in cancer survivors,” the authors of the study wrote.

SOURCE:

This study was led by Jessica M. Powers, PhD, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine in Chicago. It was published online in Cancer.

LIMITATIONS:

According to the authors, both datasets rely on self-reported data, and the cross-sectional design limits causal inference. The study population was predominantly White individuals with high income and education levels, limiting generalizability. The datasets lacked detailed assessment of cancer history, including remission status, treatment details, and time since diagnosis, as well as comprehensive clinical pain variables.

DISCLOSURES:

Lisa R. LaRowe, PhD, received support from National Institute on Aging grant K23AG088376. Dana Rubenstein, MHS, was supported by National Center for Advancing Translational Sciences grant TL1TR002555. Powers received support from National Cancer Institute grant T32CA193193.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.