Pain and Substance Use Can Interact in a Vicious Cycle Interview with:

Emily L. Zale PhD Department of Psychology Syracuse University Syracuse, New York

Dr. Zale

Emily L. Zale PhD
Department of Psychology
Syracuse University
Syracuse, New York What is the background for this study? What are the main findings?

Response: When people think of pain and substance use, it’s common for opioids to come to mind. While the opioid crisis has rightfully garnered considerable attention, our research suggests that non-opioid substances, like nicotine/tobacco, alcohol, and cannabis, are also important to consider in relation to pain. In fact, nicotine/tobacco, alcohol, and cannabis are the most commonly used substances in the US, and research into associations between pain and these non-opioid substances is continuing to increase in popularity.

Research studies usually examine either how substance use affects pain or how pain affects substance use. We looked at results from over 100 studies and put these two different types of research together to understand how pain and substance use affect each other.

On one hand, substance use can be a risk factor for chronic pain and may worsen pain over time. On the other hand, experiencing pain can motivate people to use substances and might make it harder to quit. By putting these two types of studies together, we found that pain and substance use  interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction. What should readers take away from your report?

Response:  Our research suggests that experiencing pain can make it harder for people to overcome addiction. People struggling with chronic pain and substance use are likely to benefit from treatments that address both conditions. Clinicians who treat substance use disorders should assess their patients for chronic pain, and consider addressing pain during their treatment. For example, we have evidence that pain may get worse when people go into withdrawal. Clinicians treating addiction should be prepared to help their patients manage pain during withdrawal. We also know that people use substances beyond opioids to self-medicate or cope with pain. Clinicians trying to help their patients quit smoking cigarettes, drinking alcohol or using cannabis should help their patients replace substance use with  healthy strategies to cope with pain. What recommendations do you have for future research as a result of this work? 

Response: We are pursuing multiple avenues of research, including studies to better understand the development of pain and substance use from adolescence through adulthood, the reasons that pain and substance use get caught in a vicious cycle, and studies to develop treatments that can help break the cycle. In fact, next month we will present new findings at the annual meeting of the Society for Research on Nicotine and Tobacco about the role of pain in cigarette smoking relapse and new treatments to help smokers in pain quit.

No disclosures 


A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions
Annual Review of Clinical Psychology

Vol. 15:- (Volume publication date May 2019)
Review in Advance first posted online on December 19, 2018. (Changes may still occur before final publication.)

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