medwireNews: Pain is associated with a greater likelihood of using tobacco or cannabis among cancer survivors, suggest research findings.
By contrast, pain was linked to a lower likelihood of alcohol use, which the investigators speculate “may be due to decreased social engagement and/or increased use of alternative pain management strategies that are incompatible with alcohol use (e.g., opioid therapy).”
They write in Cancer: “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 cooccurring pain and substance use in cancer survivors.”
Giving the background to the study, Jessica Powers (Northwestern University, Chicago, Illinois, USA) and co-investigators explain that “[p]ain and nonopioid substance use (tobacco, cannabis, alcohol) frequently co‐occur, but have been understudied among cancer survivors.”
To investigate further, the team collated information from two US databases of cancer survivors, Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study in 2021 and the 2020 National Health Interview Survey (NHIS).
The first analysis included 1252 adult participants of PATH, the majority of whom were women (55%), aged 65 years or older (60%), and White (88%). The mean past-week pain intensity was 3.06 points on a scale where 0 is no pain and 10 is the worst pain imaginable.
Greater past-week pain intensity correlated significantly with a greater likelihood of cigarette and e-cigarette use, as well as cannabis use, in the past 30 days, with adjusted odds ratios (AOR) of 1.34, 1.22, and 1.17, respectively.
But the likelihood of alcohol use in the past 30 days was significantly lower, at an AOR of 0.89.
For the second analysis, the team collated data for 4130 participants (56% women) of the 2020 NHIS. The average age of the participants was 65 years and most (83%) were non-Hispanic White. Just over a third (35%) reported chronic pain.
People with versus without chronic pain were significantly more likely to use cigarettes and significantly less likely to use alcohol in the past 12 months, at respective AORs of 1.65 and 0.69. The association of chronic pain with e-cigarette use did not remain significant after correcting for multiple testing.
The researchers additionally found that “[i]n both studies, cigarette smoking and pain were related to fatigue, sleep difficulties, poorer mental/physical health, and lower health‐related quality of life.”
Discussing the results, they say that “[c]ollectively, the current findings underscore the importance of developing substance cessation interventions that are tailored for cancer survivors with chronic pain.”
The team continues: “The current findings also underscore the importance of ensuring that cancer survivors are equipped with alternative pain management strategies.
“Patients have identified pain coping as a reason for using nicotine, cannabis, and alcohol, and ensuring access to alternative pain coping strategies is a critical component of substance use prevention and treatment.”
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