Chronic pain is a prevalent health issue affecting approximately 30% of cancer survivors. This pain typically persists for three months or longer, with rates increasing to 50% in individuals with advanced-stage disease. Pain and non-opioid substance use, such as cannabis, alcohol, and tobacco, commonly co-occur in cancer patients. Studies have found a link between pain and increased cigarette and cannabis use. This leads to morbidity and mortality in cancer patients. However, findings on alcohol use remain inconclusive. Existing research has several limitations, including a focus on a single substance, the exclusion of cancer-related pain, and a lack of national data.
The present study, published in Cancer Journal, examined multiple substances using U.S. national samples mainly to explore the association between pain, substance use, treatment-related side effects, mental health, and health-related quality of life (HRQOL).
A total of 1252 adults (55% female, 88% white, current cancer = 404, cancer in remission = 848) were recruited from wave 6 of the 2021 population assessment of tobacco and health (PATH), and 4130 adults (56% female, 83% white, chronic pain = 1418, no chronic pain = 2657) were from the 2020 national health interview survey (NHIS). Individuals aged ≥ 18 years were included in both studies.
In the PATH study, the mean past-week pain intensity was 3.06 out of 10 (95% confidence interval [CI], 2.89–3.24). A minimal statistical difference in pain intensity was observed for cancer remission status compared to current cancer patients (p = 0.043). Higher past-week pain intensity was significantly associated with the use of cigarettes (adjusted odds ratio [AOR] = 1.34; 95% CI, 1.26–1.42; p < 0.001), e-cigarettes (95% CI, 1.07–1.39; p = 0.003), and cannabis (AOR = 1.17; 95% CI, 1.09–1.26; p < 0.001).
Cancer survivors experiencing greater pain intensity in the past week showed a significant decrease in past 30-day alcohol consumption (AOR = 0.89; 95% CI, 0.85–0.95; p < 0.001). Pain and smoking were linked to higher fatigue (p-values [ps] < 0.010), increased emotional problems (ps < 0.004), lower HRQOL (ps < 0.001), and poorer overall health (ps < 0.001), including physical and mental health. Additionally, alcohol use showed a strong correlation with overall health (ps < 0.001) and HRQOL (p = 0.004).
From NHIS, regression analysis demonstrated that patients with chronic pain were observed more in cigarette use (AOR = 1.65; 95% CI, 1.25–2.18; p < 0.001) compared to past-30-day alcohol use (p = 0.263) and heavy alcohol drinking (p = 0.703). Chronic pain was linked to reduced alcohol use in the past 12 months compared to those without chronic pain with AOR = 0.69 (95% CI, 0.58–0.81) and p < 0.001. Smoking and chronic pain were greatly correlated with fatigue (ps < 0.001), sleep issues (ps < 0.001), anxiety (ps < 0.001), and depression (ps < 0.001), while poorly with overall health (ps < 0.001). Moreover, alcohol use was associated with better overall health (p < 0.001). No statistical significance difference was found for e-cigarette use or pain-substance interactions (ps < .05) on any health outcomes.
In conclusion, this research highlights the correlation between pain and increased cigarette smoking, e-cigarette use, and cannabis use in U.S. cancer survivors, while pain was correlated with lower alcohol use. Cigarette smoking was associated with greater treatment-related side effects, poorer mental health, and lower HRQOL. Therefore, targeted interventions are urgently needed to address the co-occurrence of pain and substance use among cancer populations.
Reference: Powers JM, LaRowe LR, Rubenstein D, Paice JA, Hitsman B, Rini CM. Relationship between pain and nonopioid substance use in two national samples of cancer survivors. Cancer. 2025;131(4):e35701. doi:10.1002/cncr.35701
