267: Pain Catastrophizing and Substance Use for Pain Coping Among Older Adults with Chronic Pain

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology, Pain in Special Populations

Background and Aims: Converging evidence from the general population suggests that pain can motivate the use of nonopioid substances such as nicotine, alcohol, and cannabis. This use may be driven in part by maladaptive cognitive-affective responses to pain (e.g., pain catastrophizing[1]). However, less is known about substance use for pain-coping among older adults specifically. This research gap is surprising given the high prevalence of chronic pain in later life and the heightened risk of adverse substance-related effects[2-4]. Therefore, these analyses examined use of nonopioid substances for pain coping and their associations with pain catastrophizing among adults aged ≥65 with chronic pain.

Methods: A sample of 951 older adults (Mage = 74; 55.9% female) with chronic pain were recruited from the AmeriSpeak® Panel – a probability-based panel designed to be representative of the United States population. Participants were asked about their current use of cigarettes, alcohol, and cannabis. Participants who endorsed current use of each substance were subsequently asked if they had ever used that substance to cope with pain. Participants completed a two-item measure of pain catastrophizing (characterized by rumination, magnification, or feelings of helplessness about pain). We applied survey design weights in all statistical analyses to generate nationally representative estimates.

Results: Over one-third (40.7%) of older adults who smoked cigarettes reported that they used cigarettes to help cope with pain. Among those who used alcohol, 18.7% said they used alcohol to help cope with pain. Almost three-quarters (71.1%) of older adults who used cannabis reported that they used it for pain-coping. Pain catastrophizing was significantly associated with use of cigarettes (OR=1.26, p<.01), alcohol (OR=1.37, p < 0.0001), and cannabis (OR=1.456, p < 0.01) to cope with pain.

Conclusions: Older adults with chronic pain frequently report using nonopioid substances for pain-coping. In addition, higher levels of pain catastrophizing may be associated with greater risk. It is possible that pain catastrophizing increases both negative emotions and pain intensity, and motivates older adults to turn to nonopioid substances to self-medicate pain and associated negative affect. This finding is alarming because substance use can further exacerbate pain in the long-term and is associated with poorer health outcomes[1]. Tailored interventions to reduce substance use for pain coping in older adults are sorely needed, and pain catastrophizing represents a promising intervention target.

References: 1. Ditre JW, Zale EL, LaRowe LR. A reciprocal model of pain and substance use: Transdiagnostic considerations, clinical implications, and future directions. Ann Rev Clin Psychol. 2019;15:503–528. doi: 10.1146/annurev-clinpsy-050718-095440.

2. LaRowe LR, Miaskowski C, Miller A, et al. Prevalence and Sociodemographic Correlates of Chronic Pain Among A Nationally Representative Sample of Older Adults in the United States. J Pain. 2024/06/25/ 2024:104614. doi: 10.1016/j.jpain.2024.104614

3. Trifiro G, Spina E. Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab. 2011;12(7):611–620. doi: 10.2174/138920011796504473

4. Mangoni AA, Jackson SH. Age‐related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14. doi: 10.1046/j.1365-2125.2003.02007.x

Presenting Author: Lisa R. LaRowe
Submitting Author: Lisa LaRowe

Senior Author: Christine S. Ritchie

IASP 2026 Global Year theme of Neuropathic Pain: No

• Lisa R. LaRowe: PhD - Massachusetts General Hospital; Harvard Medical School
• Meera Srinivasan: MS - Massachusetts General Hospital
• Andrea Mayfield: MPH - NORC at the University of Chicago
• John Dombrowski: MA - NORC at the University of Chicago
• Francis J. Keefe: PhD - Duke University School of Medicine
• Alexander K. Smith: MD, MS, MPH - University of California, San Francisco; San Francisco VA Medical Center
• Bruce A. Cooper: PhD - University of California, San Francisco
• Lee-Jen Wei: PhD - Harvard T.H. Chan School of Public Health
• Christine Miaskowski: RN, PhD - University of California, San Francisco
• Christine S. Ritchie: MD, MSPH - Massachusetts General Hospital; Harvard Medical School