Longitudinal Associations Between Pain in Adolescence and Substance Use in Early Adulthood

Introduction:Chronic pain in adolescence is quite common (findings regarding the prevalence of multiple pains range from 4-49%; King et al., 2011); research indicates a link between the experience of childhood chronic illness and an increase in certain types of health risk behavior during adolescence, including substance use (Suris, Michaud, Akre, and Sawyer, 2008). Treatment for pain may include opiate medications; among adults, frequent as-prescribed use of opiates is associated with abuse of other substances (Sullivan, Edlund, Steffick and Unützer, 2005). However, there has been minimal longitudinal research investigating the potential link between chronic pain in youth and later substance use. The goal of this study was to determine whether chronic pain during adolescence was associated with alcohol and marijuana use during the transition to adulthood.

Method:Data were drawn from the publicly available Panel Study of Income Dynamics (PSID). PSID is a longitudinal, nationally representative household survey. Youth included in this study (n=879; 46% male, 54% female; 45% African-American, 45% White) were between the ages of 12 and 17 at the initial assessment (2002) and were followed-up 5 years later (2007). A single item about the frequency of physical pain experienced in the past month, taken from the National Longitudinal Study of Adolescent to Adult Health (Add Health), was used to gauge pain at the initial assessment. Questions regarding frequency of alcohol and marijuana consumption at both assessments were taken from Add Health. Multiple regression analyses were conducted separately for alcohol and marijuana. Pain and substance use in adolescence were the independent variables for each analysis and substance use in early adulthood was the dependent variable for each analysis.

Results:Adolescents who reported more frequent pain during adolescence used both alcohol and marijuana more frequently five years later, even after adjusting for frequency of use of that substance during adolescence (alcohol: B=.12, SE=.04, t=3.12, p<.01; marijuana: B=.01, SE=.005, t=2.15, p<.05).

Discussion: This study finds that frequent pain in adolescence significantly predicts increased use of alcohol and marijuana in early adulthood. Planned additional analyses will examine associations between childhood chronic pain and not-as-prescribed prescription drug use as well as the potential moderating influences of age and gender. Exploring this association further may support a call for focused longitudinal study of teens suffering chronic pain and development of prevention efforts geared specifically toward them.