Indirect effects of emotion regulation in the relationship between pain and cannabis use in adults 18-64 years

Ty S Schepis; Andrew H Rogers; Liliana Munoz; Michael J Zvolensky

doi:10.1016/j.addbeh.2024.107983

Indirect effects of emotion regulation in the relationship between pain and cannabis use in adults 18-64 years

Addict Behav. 2024 Jun:153:107983. doi: 10.1016/j.addbeh.2024.107983. Epub 2024 Feb 10.

Authors

Ty S Schepis¹, Andrew H Rogers², Liliana Munoz³, Michael J Zvolensky⁴

Affiliations

¹ Department of Psychology, Texas State University, USA; Translational Health Research Center, Texas State University, USA; Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, USA. Electronic address: schepis@txstate.edu.
² Department of Psychology, University of Houston, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA.
³ Department of Psychology, Texas State University, USA.
⁴ Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, USA; HEALTH Institute, University of Houston, USA.

PMID: 38367507
DOI: 10.1016/j.addbeh.2024.107983

Abstract

Introduction: Individuals with chronic pain often receive prescription opioid medication, and they may use cannabis to treat pain as well, although the risks of cannabis-opioid co-use are significant. This study aimed to investigate whether two transdiagnostic factors, emotion regulation and distress tolerance, had significant indirect effects in the relationship between pain and cannabis use in adults with chronic pain and an opioid prescription.

Methods: Participants (n = 450; mean age = 38.6 ± 11.09) were recruited using Qualtrics panel service and were 75 % female and 79 % White, non-Hispanic. Participants completed a 30-minute self-report survey capturing three-month cannabis use, the Difficulties in Emotional Regulation Scale (DERS), and the Distress Tolerance Scale (DTS). The Graded Pain Scale (GCPS) assessed pain severity/intensity and disability. Analyses used the SPSS PROCESS macro, with both single (i.e., one transdiagnostic factor) and parallel indirect effects (i.e., both the DERS and DTS) examined.

Results: There were statistically significant indirect effects for both the DERS and DTS in the relationship between pain intensity or disability and three-month cannabis use in single factor models. In the parallel indirect effect model, only the DERS was statistically significant (intensity indirect effect coefficient = 0.0195 % confidence interval [95 %CI] = 0.0065, 0.390; disability indirect effect coefficient = 0.0147, 95 %CI = 0.0055, 0.0274).

Conclusions: When examining parallel indirect effects, only emotional regulation and not distress tolerance mediated the relationship between chronic pain and cannabis use among those with an opioid prescription. Clinically, interventions aimed at improving emotional regulation in individuals with chronic pain can help limit cannabis and opioid co-use.

Keywords: Analgesics; Cannabis; Chronic pain; Distress tolerance; Emotional regulation; Opioid.

MeSH terms

Adult
Analgesics, Opioid / therapeutic use
Cannabis*
Chronic Pain* / drug therapy
Emotional Regulation*
Female
Hallucinogens*
Humans
Male
Middle Aged
Opioid-Related Disorders* / psychology

Substances

Analgesics, Opioid
Hallucinogens