Background & Aims
Advances in chronic pain in the last 50 years have led to better diagnostics, treatments, and outcomes. Yet, substance abuse (SA) concerns persist. Chronic pain has a complex relationship with SA, particularly opioid use disorder (OUD).1 Psychosocial and mental health factors often co-occur with chronic pain, including depression and anxiety.2 Chronic pain can affect HPA activation and neural reward circuits leading to emotional distress and increase risk for SA.3 Most research on chronic pain and SA involves middle age and older adults. Less is known about the vulnerability of younger individuals with chronic pain. This study sought to examine psychosocial and substance abuse correlates of chronic pain in adolescence and young adolescence and young adulthood. This study also aimed to understand the extent to which chronic pain early in life can be predictive of future health and mental health problems, SA, and OUD.
Methods
Participants were selected from the public use National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of adolescents/young adults in the U.S.4
6504 participants who completed the Wave I health/mental health/pain questionnaire were included in this study. Pain was assessed again in Wave II one year later. Wave IV was collected 14 years later and assessed health, mental health, and SA outcomes. In line with prior research, pain was coded as chronic if it occurred (1) almost every day or (2) every day in the last year, in one or more of the following locations: head, stomach, chest or muscles/joints.5 Depression was assessed with the CESD.6,7 Anxiety (fearfulness, trouble relaxing) was assessed in line with prior research.8 Multivariate logistic regression assessed relationships between chronic pain, mental health, and SA, controlling for age, sex, race, and ethnicity.
Results
Mean age at baseline was 16 years (SD=1.77; range 12-21), with males (48.4%) and females (51.6%) evenly distributed. Chronic headache and muscle/joint pain were the most common pain complaints. Individuals with early life chronic pain (21.9% of sample) had higher depression and anxiety symptoms and were more likely to engage in maladaptive coping behaviors, such as smoking cigarettes, drinking alcohol and using marijuana, at baseline. In predictive multivariate logistic regression models, controlling for demographics and baseline mood/anxiety, individuals with early life chronic pain were statistically more likely to abuse: any prescription drug (AOR=1.44, p<.001), prescription opioids (AOR=1.51, p<.001), cocaine (AOR=1.20, p=.04), and methamphetamine (AOR=1.43, p=<.001) in later adulthood. They also were more likely to have poorer general health, PTSD (AOR=1.91, p<.001), panic/anxiety (AOR=1.58, p<.001), depression (AOR=1.52, p=<.001), and attempted suicide (AOR=1.93, p=.02).
Conclusions
Chronic pain early in life is connected to both mental health and SA concerns. This study reaffirms that early life chronic pain is common, with predominant musculoskeletal and headache pain.9 Early life chronic pain is also associated with depression, anxiety, and risk seeking SA behaviors, including smoking cigarettes, drinking alcohol, and abusing marijuana. Longitudinal analyses showed that early life chronic pain is predictive of numerous concerns in adulthood, including poorer health, mental health, and SA outcomes. Studies suggest that young people are notably influenced by environmental and psychosocial stimuli, partly due to greater neuroplasticity during this age range.10 Further evaluation and early screening of biopsychosocial risk factors, such as chronic pain and mental health concerns in young age, may help identify vulnerable individuals who may benefit from evidence based cognitive behavioral interventions to promote resilience and adaptive coping early in life.
References
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