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Pain Severity and Interference Associated with Increased Use of Substances – But Differently for Women and Men

January 6, 2022
Meg Brunner, MLIS
Charron E, et al. Pain severity and interference and substance use among community pharmacy patients prescribed opioids: A secondary analysis of the PHARMSCREEN study. J Pain 2022 (in press). Find it in the CTN Dissemination Library.
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Addiction Science Made Easy
June 2022
CTN Dissemination Library


Chronic pain is a serious public health concern in the U.S., impacting about 1 in 5 American adults. In parallel, there has also been a significant rise in chronic opioid use in the U.S., with about 2% - 3.6% of American adults using prescription opioids regularly, approximately half of them using them long-term.

Several studies have found that pain severity and pain interference – pain interfering with daily activities – Abstract Multi colored image of a male and female profiles overlappingare associated with increased risk of opioid misuse and dependence. But some research has also linked pain severity and interference to misuse of other substances as well. Also, some studies have identified sex and/or gender as a factor impacting these associations. 

This secondary analysis of the CTN PHARMSCREEN study (CTN-0093) sought to examine all these elements – pain severity and interference and risky opioid and other substance use behaviors for women vs. men -- in a community pharmacy population prescribed opioids for chronic pain. 

The PHARMSCREEN study was a one-group, cross-sectional study conducted in 19 community pharmacies located in Indiana and Ohio to evaluate the use of an opioid risk measure, the NarxScore, integrated into the prescription drug monitoring program (PDMP). This study leveraged the resulting linked patient-reported and controlled substance dispensing data to examine associations between pain and substance use. 

Researchers found that the prevalence of risky prescription opioid use and non-opioid substance use (sedatives and tobacco) -- except for alcohol -- increased with worsening pain severity and interference. 

Interestingly, gender played a significant role – greater pain severity led to less alcohol use but greater tobacco use for women, with the opposite being true for men.  

Conclusions: In a community pharmacy population prescribed opioids, pain severity and interference with daily activities were associated with increased use of non-medical opioids, sedatives, and tobacco, as well as decreased use of alcohol, though these associations differed by gender. Reducing the long-term risk of substance use disorders among patients with persistent pain means finding effective ways to reduce not just pain symptoms but also ways in which pain and substance misuse might overlap, like decreased hedonic capacity, increased stress, e.g. The development of gender-specific strategies to reduce or prevent substance use disorders among individuals living with chronic pain could also be extremely helpful.

These findings underscore the critical need for pain and substance use management programs in non-specialized clinical settings like community pharmacies. Community pharmacies are ideally situated to deliver such interventions because pharmacists are trusted, skilled health professionals and 91% of Americans live within 5 miles of a pharmacy.