Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference

Abstract

Introduction:Chronic pain in late adolescence and young adults is understudied and poorly characterized.Objectives:We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity.Methods:Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference.Results:Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference.Conclusion:Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.

A scoping review of chronic pain in emerging adults

“… 31 , 85 In addition, in a review of tertiary pain clinic patients' medical charts, women reported more pain locations than men. 3 …”

The relationship between pain and suicidal vulnerability in adolescence: a systematic review

“…74 Hence, exposure to chronic pain during the sensitive adolescent period 75 may interfere with adaptive neuro-cognitive development (e.g., acquisition of self-regulatory skills) and social maturation (e.g., independence), making adolescents more susceptible to prolonged emotional difficulties and at its worst suicidality. 28,75 However at the same time, adolescents are shielded from some of the harsher socioeconomic effects of chronic disabling pain that may be experienced in adulthood (e.g., inability to work), and they are likely to be living in a social context which provides support for daily tasks. These highly speculative hypotheses await further scrutiny, and a systematic exploration of developmental similarities and differences underpinning the pain-suicidality association in adolescents and adults is warranted to tailor early interventions to patients' needs.…”

“…22,26 However, the manifestation of pain may vary between adolescents and adults, 21,27 and its effects may be particularly detrimental in adolescence, particularly by interfering with the adaptive development during this critical period. 28 Given the growing support for a relationship between pain and suicidality in adults (see Racine 13 , Rizvi et al 14 and Tang et al 15 ), establishing whether a similar relationship exists in adolescents has the potential to enhance our understanding of the interplay between physical and mental suffering in this age group, and to inform the development of prevention strategies. 6,29 In this paper, we report the findings of a systematic review designed to synthesise and critically evaluate the existing empirical evidence for an association between pain and suicidality in adolescence.…”

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

“…Poor access to care for youth living with chronic pain has been identified as a longstanding problem and research priority for patients and families 7,10 . If healthcare services or care delivery are compromised, youth with pain are at risk of developing mental health concerns (including post-traumatic stress disorder (PTSD), depression, anxiety and suicide), deteriorations in functioning, and substance use disorder 11,12 . Moreover, many youth living with pain have previously existing mental health co-morbidities which places them at even greater risk 13 .…”

“… 7 , 10 If health care services or care delivery is compromised, youth with pain are at risk of developing mental health concerns (including posttraumatic stress disorder [PTSD], depression, anxiety, and suicide), deteriorations in functioning, and substance use disorder. 11 , 12 Moreover, many youth living with pain have previously existing mental health comorbidities, which places them at even greater risk. 13 Starting in mid-March 2020 when widespread public health restrictions began in Canada, young people with chronic pain and their families have faced many challenges as ambulatory chronic pain programs halted new in-person consults, follow-up appointments, and individual therapy sessions.…”