Among adolescents with chronic pain who reported cannabis use—25.3% of the full sample—more than 75% said they used it to manage symptoms such as pain, sleep disturbances, and anxiety, resulting in an overall instrumental use rate of 19.6%, according to a recent study.

In a cross-sectional study, researchers led by Joe Kossowsky, PhD, of the Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, evaluated the prevalence, risk perceptions, and motivations for cannabis use (CU) among adolescents receiving treatment for chronic pain. The study, published in JAMA Network Open, included 245 patients (mean age, 16.9 years; 68.6% female) recruited from a pediatric pain clinic in the Northeast United States between September 2021 and May 2024. Participants completed validated self-report instruments measuring demographics, pain characteristics, psychological functioning, and substance use behaviors.

Lifetime CU was reported by 25.3% (62 of 245) of patients, with a mean age at first use of 15.3 years. Past-year and past-month CU prevalence was 22.9% and 16.3%, respectively. Among those reporting CU, 77.4% (48 of 62) endorsed instrumental use (IU), defined as cannabis use to alleviate physical or psychological symptoms. Pain was the most cited symptom (93.8%), followed by sleep disturbances (72.9%) and anxiety (68.8%). This equated to an overall IU prevalence of 19.6% in the full sample.

Compared with nonusers, patients who endorsed CU were older, had a lower proportion of female patients, and reported higher levels of pain interference and depressive symptoms. Among cannabis users, those who reported IU were younger and had greater functional disability than non-instrumental users. There were no observed group differences in pain intensity or frequency between these subgroups.

Most patients with CU reported using cannabis on either 3 to 5 occasions or more than 40 occasions over their lifetime. Preferred methods of administration included edibles (51.6%), vaporizers (45.2%), and joints (43.5%). Adverse effects such as hallucinations and anxiety were infrequently reported.

Patients with CU were more likely to believe cannabis is safe because it is natural, whereas nonusers more often cited addiction, physical and psychological harm, and parental disapproval as reasons for abstinence.

The researchers concluded that cannabis use is common among treatment-seeking adolescents with chronic pain, with a majority using cannabis to manage symptoms despite limited evidence of efficacy. These findings highlight the importance of targeted education regarding the risks of self-medication and the need for developing alternative, evidence-based coping strategies in pediatric pain care.

The authors reported no conflicts of interest.

Source: JAMA Network Open

Expert Commentary by Zeeshan Khan, MD, FAAFP, CMD, Treasurer, New Jersey Academy of Family Physicians, Associate Professor, Rutgers Robert Wood Johnson Medical School at Centrastate Medical Center

Balancing Empathy and Discouraging Cannabis Use

Clinicians should balance empathy for adolescents coping with chronic pain and emotional distress. Understanding the patient's perspective is crucial in this process. This involves acknowledging the perceived benefits of cannabis while also providing evidence-based information about its risks and limitations. By doing so, clinicians can ensure their patients are well-informed about potential adverse effects, such as anxiety, addiction, and psychosis associated with THC, a primary psychoactive compound in cannabis.

Alternative Strategies for Pain, Sleep, and Anxiety

Physicians should prioritize alternative strategies that are evidence-based and accessible to teens. These include:

• Cognitive Behavioral Therapy (CBT): Effective for managing chronic pain and anxiety by changing thought patterns and behaviors.

• Mindfulness-Based Interventions: Such as mindfulness meditation, which can help reduce stress and improve sleep quality.

• Physical Therapy: Tailored exercises to improve function and reduce pain.

• Pharmacological Options: Non-opioid analgesics such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and for sleep, melatonin or prescription sleep aids under close supervision.

Role in Cannabis Education and Risk Screening

Clinicians play a crucial and proactive role in early cannabis education and risk screening among youth with chronic pain or mood disorders. This involves:

• Educating Patients and Families: Provide comprehensive education about the potential risks of cannabis use. This includes its impact on mental health, such as increased risk of anxiety and depression, and its potential for addiction, especially in adolescents whose brains are still developing.

• Screening for Cannabis Use: Regularly assess for cannabis use and its motivations to provide targeted interventions.

• Promoting Healthy Coping Mechanisms: Encourage alternative coping strategies for pain and emotional distress.

• Collaboration with Mental Health Professionals: Involve mental health professionals in comprehensive care. Clinicians can feel more supported and part of a team by involving specialists when needed, providing the best care for their patients.

In light of shifting public attitudes toward cannabis and the trend of legalization in many regions, clinicians must stay updated on the latest research and guidelines. This will enable them to provide informed care and education to their patients.

References:

Harrison TE, Bruce BK, Weiss KE, et al. Marijuana and chronic nonmalignant pain in adolescents. Mayo Clin Proc. 2013 Jul;88(7):647-50. doi: 10.1016/j.mayocp.2013.04.018. Epub 2013 Jun 17. PMID: 23787068.

Kansagara D, O'Neil M, Nugent S, et al. Benefits and Harms of Cannabis in Chronic Pain or Post-traumatic Stress Disorder: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs (US); 2017 Aug. RESULTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK476452/

Busse JW, Vankrunkelsven P, Zeng L, et al. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ. 2021 Sep 8;374:n2040. doi: 10.1136/bmj.n2040. PMID: 34497062.