Associations Between Pain and Substance Use Among Individuals Diagnosed with Ehlers-Danlos Syndromes or Generalized...

Pain and substance use frequently co-occur. Research indicates pain motivates alcohol, cannabis, and tobacco use. Pain is also highly co-morbid with Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorder (G-HSD), however, research on pain and substance use in these populations remains limited.

Descriptive, cross-sectional, retrospective chart review was conducted of 533 patients (89% female) seen at the GoodHope EDS Clinic at Toronto General Hospital and diagnosed with EDS or G-HSD. Patients provided self-report data on pain and substance use. Analyses included descriptive statistics and bivariate correlations.

Half of the sample reported clinically significant pain severity (55%) and interference (57%). Alcohol use was reported by half of the sample (59%) and 18% reported prescription opioid use. Cannabis use was reported by 48%, with 69% using ≥ 4 times per week. Patients who used cigarettes (14%) smoked a median of 8.0 cigarettes per day (IQR = 4.0-12.0). Pain severity and interference were positively associated with cannabis use frequency, quantity, opioid use, and cigarette use (ρ = .13 - .28, ps < .05), and negatively associated with alcohol use (ρ = -.20 and -.20, ps < .05).

Greater pain severity and interference were associated with greater cannabis and cigarette use, but lower alcohol use. Longitudinal studies are needed to determine if pain is a motivator for cannabis/cigarette use and/or if persistent use exacerbates pain in this population. Research should also examine if negative associations between pain and alcohol use reflect alcohol analgesia (i.e., lower pain at greater drinking) or avoidance due to the exacerbation of co-occurring conditions with EDS/G-HSD.