A study by Duke University School of Medicine reveals a complex cycle between substance use and pain.
The study, published Aug. 21 in the journal Pain, examined data from 32,000 adults and found a two-way relationship that evolves over time: pain can drive substance use, and substance use can worsen pain. This cycle can result in a perpetual pain loop for the one in five Americans who experience chronic pain.
According to the data, the co-use of cannabis, also known as marijuana, and tobacco more than doubled the odds of experiencing moderate to severe pain later on compared to using neither of these substances.
“These findings suggest that the co-use of cannabis and tobacco might amplify pain, creating a cycle that’s hard to break,” said lead study author Dana Rubenstein, a medical student at Duke University School of Medicine.
It’s concerning as Duke research led by Rubenstein shows prevalence of cannabis and tobacco co-use is on the rise.
Rubenstein, a researcher in the Department of Psychiatry and Behavioral Sciences and Clinical and Translational Science Institute, collaborated with study co-authors including tobacco policy researchers Maggie Sweitzer, PhD, F. Joseph McClernon, PhD, and Michael Green, PhD; and pain researcher, Francis Keefe, PhD.
Researchers examined data from the 2015-2021 Population Assessment of Tobacco and Health Study, a nationwide sample of U.S. adults, to understand how pain and substance use influence each other.
Even though pain management is one of the most common reasons reported for using cannabis, the science behind its effectiveness at treating most types of pain is thin.
“People might be using cannabis and tobacco to ease their pain, but this can be harmful to their health and delay them from getting the medical treatment that can help them in the long run,” Rubenstein said.
The findings represent a phenomenon known as a bi-directional model in which substance use and chronic pain reinforce each other.
While the precise mechanisms underlying this relationship remain unclear, researchers believe individuals who use substances to cope with pain may experience a cycle of immediate relief followed by heightened sensitivity to pain when the substance wears off.
This can make it difficult for the growing number of Americans using cannabis and tobacco for pain to quit, leading to a sustained pattern of both substance use and chronic pain.
“Despite the prevalence of pain in the population and prevalence of smoking and using cannabis for pain relief, we really don’t know a lot about how these factors interact with one another,” said senior study author McClernon, professor in the Department of Psychiatry and Behavioral Sciences whose research delves into tobacco use and regulation of tobacco products in the U.S.
“There’s a significant gap in our understanding of the mechanisms at play here, especially with regard to the cannabis and tobacco interactions,” he said.
Funding: The study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health through grant award TL1TR002555.