Relationship between pain and nonopioid substance use in two national samples of cancer survivors

Significance: Pain and nonopioid substance use (tobacco, cannabis, alcohol) frequently co-occur, but have been understudied among cancer survivors. Even less work has examined whether pain and nonopioid substance use is related to other cancer treatment-related side effects, mental health, and health-related quality of life. Methods: Two national datasets were used to assess a range of variables and confirm patterns. Study 1 included 1252 adults (88% White; 55% female; 60% aged ≥65) from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study, and Study 2 included 4130 adults (83% White; 56% female; M age = 66) from the 2020 National Health Interview Survey who reported a lifetime cancer diagnosis. Regression analyses were conducted separately by study. Results: Study 1 results indicated that past-week pain intensity was associated with greater likelihood of using cigarettes, e-cigarettes, and cannabis (ps <.003) and lower likelihood of using alcohol (p <.001). Study 2 results indicated that chronic pain (vs. no chronic pain) was associated with greater likelihood of cigarette smoking (p <.001) and lower likelihood of alcohol use (p <.001). In both studies, cigarette smoking and pain were related to fatigue, sleep difficulties, poorer mental/physical health, and lower health-related quality of life. Conclusion: Pain is associated with greater likelihood of tobacco and cannabis use among cancer survivors. Given that substance use may impact cancer treatment and its side effects and contribute to pain chronification, there is an urgent need to develop tailored interventions for cooccurring pain and substance use in cancer survivors.