Pain is associated with a higher risk of tobacco and cannabis use among cancer survivors, according to a study published in Cancer. 

Pain is a common complaint of patients who have survived a cancer diagnosis; estimates suggest that approximately one-third of patients experience chronic pain (pain for 3 or more months). Studies have established a link between pain and nonopioid substance use in the general population, but this has largely been left unexplored among cancer survivors. 

Jessica M. Powers, PhD, of Northwestern University Feinberg School of Medicine in Chicago, Illinois, and colleagues used 2 national datasets to investigate the relationship between pain in cancer survivors and nonopioid substance use. The first dataset was Wave 6 of the Population Assessment of Tobacco and Health Study, which recruited 1252 adult patients with a self-reported history of cancer between March and November 2021. Approximately one-third (31%) of patients reported current cancer, and 69% reported cancer in remission. 

In this study, higher levels of pain intensity in the preceding week were associated with higher odds of cigarette and e-cigarette use. Furthermore, pain was associated with higher risk of cannabis use in the last 30 days. Both past-week pain intensity and cigarette smoking were independently associated with fatigue and poorer physical, mental, and overall health. However, past-week pain intensity was associated with lower levels of 30-day alcohol use. 

The second study was the 2020 National Health Interview Survey, which was limited to 4130 adult patients with a self-reported history of cancer. In this study, cancer survivors with chronic pain were more likely to report be cigarette and e-cigarette use; however, chronic pain was associated with a lower odds of preceding 12-month alcohol use. 

Both chronic pain and cigarette smoking had an independent association with higher levels of past-week fatigue. In addition, chronic pain and cigarette smoking were associated with greater difficulties falling and staying asleep. Cigarette smoking and chronic pain were associated with a higher frequency of anxiety, depression, and lower perception of overall health. 

“Collectively, the current findings underscore the importance of developing substance cessation interventions that are tailored for cancer survivors with chronic pain,” Dr Powers and colleagues wrote. “Although preliminary research has explored the utility of an integrated smoking cessation and pain management intervention for cancer survivors, we are unaware of previous interventions targeting cannabis and/or alcohol use among this population.” 

Disclosures: This research was supported by the National Institute on Aging, the National Cancer Institute, and the National Center for Advancing Translational Sciences. Please see the original reference for a complete list of disclosures.