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The following is a summary of “Bidirectional relationships between pain and patterns of cannabis and tobacco use in a US nationally representative sample,” published in the August 2024 issue of Pain by Rubenstein et al.

Tobacco and cannabis use, to a great extent, is becoming the leading cause of chronic pain in one-fifth of the adult population in the US, and bidirectional relationships between tobacco and pain have been demonstrated. 

Researchers conducted a retrospective study to estimate the effects of substance use (cannabis and tobacco) on later pain intensity and pain intensity on later substance use.

They collected data from 31,983 adults through biennial surveys (2015-2021) of the US representative Population Assessment of Tobacco and Health Study (n=71,055 pairs of consecutive surveys: T1 and T2). Past-week pain intensity was categorized as ≤4/10 (no/low pain) or >4/10 (moderate/severe pain). Substance use was classified into mutually exclusive categories (past 30 days): no cannabis/tobacco use, exclusive cannabis or tobacco use, and co-use. Logistic regression was used to evaluate whether T1 substance use influenced moderate/severe pain at T2, while multinomial models assessed if pain status at T1 affected substance use at T2.

The results showed that on comparing with no cannabis/tobacco use at T1, co-use (OR: 2.29 [95% CI: 2.09-2.51]), exclusive tobacco use (2.00 [1.86-2.14]), and exclusive cannabis use (1.35 [1.13-1.61]) were all associated with moderate/severe pain at T2. Moderate/severe pain at T1 increased the odds of co-use (2.43 [2.22-2.66]), exclusive tobacco use (2.12 [1.98-2.28]), and exclusive cannabis use (1.46 [1.29-1.65]) compared to no cannabis/tobacco use at T2, and also increased the odds of co-use at T2 compared with exclusive cannabis/tobacco use.

They concluded a bidirectional relationship between pain and the exclusive use and co-use of cannabis and tobacco and indicated potential synergy in the co-use of cannabis and tobacco concerning pain.

Source: journals.lww.com/pain/abstract/9900/bidirectional_relationships_between_pain_and.687.aspx