181: Day-to-day factors associated with cannabis craving and THC intake among persons with chronic pain

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology

Background and Aims: Cannabis has been increasingly used for symptom management among patients with chronic pain [1]. Despite the potential benefits of cannabis, high-frequency cannabis use and THC intake can lead to health-related problems. To date, the bulk of cannabis research has focused on non-medical cannabis use and little is known on the factors that contribute to cannabis craving and THC intake among patients with chronic pain [2]. Aims: To examine the influence of pain intensity, negative affect (i.e., nervousness, depressed mood), and sleep on day-to-day exacerbations in cannabis craving. We also examined the contribution of cannabis craving to daily THC intake.

Methods: In this ecological momentary assessment (EMA) study, patients with chronic non-cancer pain (n = 103) were prompted to complete electronic diaries in the morning, afternoon, and evening for 10 consecutive days. These time-based diaries assessed a host of sleep, pain, psychological, and cannabis-related variables. Patients also completed event-based diaries every time a cannabis product was used over the 10-day study period. These event-based diaries assessed a host of psychological and cannabis-related variables, including the quantity of THC used and cannabis craving.

Results: Multilevel logistic regression analyses revealed that heightened daily levels of pain intensity and negative affect (i.e., nervousness, depressed mood) were associated with a greater likelihood of exacerbations (i.e., ≥ 20-point increase on a 100-point scale) in cannabis craving (both p’s < .05). However, previous night sleep quality was not associated with cannabis craving exacerbations (p > .05). Multilevel analyses indicated that heightened cannabis craving was associated with an increased likelihood of momentary cannabis use (p < .01) and greater standardized THC intake (p < .05).

Conclusions: A novel finding from our study is that pain intensity and psychological factors contributed to acute exacerbations in cannabis craving. Furthermore, our results suggest that cannabis craving can increase cannabis use frequency and standardized THC intake. These findings could help physicians identify patients with chronic pain who require closer monitoring to prevent escalations in cannabis use, as high THC intake has been associated with cannabis-related problems [3,4,5].

References: [1] Boehnke KF, Wu CL, Clauw DJ. Thoughtfully Integrating Cannabis Products Into Chronic Pain Treatment. Anesth Analg. 138:5-15, 2024

[2] Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, Brink WVD, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. Int J Drug Policy. 99:103381, 2022

[3] Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 7:16, 2021

[4] Lake S, Murray CH, Henry B, Strong L, White K, Kilmer B, Cooper ZD. High-Potency Cannabis Use and Health: A Systematic Review of Observational and Experimental Studies. Am J Psychiatry.appiajp20240269, 2025

[5] Mohiuddin M, Blyth FM, Degenhardt L, Di Forti M, Eccleston C, Haroutounian S, Moore A, Rice ASC, Wallace M, Park R, Gilron I. General risks of harm with cannabinoids, cannabis, and cannabis-based medicine possibly relevant to patients receiving these for pain management: an overview of systematic reviews. Pain. 162:S80-S96, 2021

Presenting Author: Amanda Sirois
Submitting Author: Amanda Sirois

Senior Author: Marc O. Martel

IASP 2026 Global Year theme of Neuropathic Pain: No

• Amanda Sirois: BSc - McGill University
• Lucas Frankel - McGill University
• Gabriella Spiegler - McGill University
• Jiaqi Bi - Western University
• Daniel Rosenthal - Concordia University
• Maria Verner - McGill University Health Centre
• Abdulelah Binshihah - McGill University Health Centre
• Jonathan Hudon - McGill University Health Centre
• Maayan Ben-Sasson - McGill University Health Centre
• M. Gabrielle Pagé - McGill University Health Centre
• Jordi Perez - McGill University
• Mark Ware - McGill University
• Mary-Ann Fitzcharles - McGill University
• Marc O. Martel: PhD - McGill University