Frequency of Cannabis Use and Pain Intensity: Results from a National Sample
Authors: Joseph Verlin , Dyal Brenda , Schoppee Tasha , Roach Keesha , Ezenwa Miriam , Yao Yingwei , Wilkie Diana 
Published: March 2022

Background: Chronic pain has become a leading public health concern with roughly 20% of Americans currently living with chronic pain. Individuals living with chronic pain are more likely to report lower quality of life, additional comorbidity, and increased medical expenditures than individuals without pain. Many individuals have initiated cannabis use to manage their pain as an alternative to opioid use. However, studies examining associations between cannabis use and pain intensity rarely include the frequency of cannabis. Aim: Our study aim was to address this scientific gap by elucidating the frequency of cannabis use and its association with pain intensity in an adult sample from across the United States. Methods: In a cross-sectional study, we surveyed N=2,206 adults using three sampling approaches, a national panel, a Florida panel, and a community-engaged sample. Participants completed surveys including pain and substance use. Pain intensity was measured using the Pain Intensity Number Scale (PINS, 0-10 scale) by asking participants to rate their current pain and least and worst in the past 24 hours. Average Pain Intensity (API) was the mean of the aforementioned PINS scores. Frequency of cannabis use was measured by asking individuals to indicate any past 30 day use and to indicate how often they currently use cannabis: once a month, more than once a month but less than weekly, 1 to 6 days a week, or every day. Bivariate and multiple linear regressions were utilized to identify associations between pain intensity, cannabis use, and sociodemographic factors. Results: Our sample was majority female (54.1%), non-Hispanic White (63.1%), and 45.9 ± 17.60 (SD) years of age. Participants reported an API score of 1.50 ± 2.49. For the 35.3% reporting pain greater than 0, the API score was 4.26 ± 2.40. Of the responding participants (n=600), 52% reported they never used cannabis and 25% indicated current cannabis use; with 9.0% of our sample indicating use once a month, 5.7% indicating use more than once a month but less than weekly, 4.0% reporting use 1 to 6 days a week, and 6.1% reporting using every day. Sociodemographic factors including race/ethnicity, education, and employment were associated with pain intensity at the bivariate level. Substance use factors including frequency of cannabis use and alcohol use were also associated with pain intensity at the bivariate level. After controlling for sociodemographic and substance use factors, using cannabis once a month (β=1.879), more than once a month but less than weekly (β=0.981), 1 to 6 days a week (β=1.830), and every day (β=1.491) were associated with API (p<.001). Additionally, having a disability (β=1.965) was associated with API (p≤.001). Discussion: We found above average pain intensity in this sample and about 48% of respondents were using cannabis. Increased frequency of cannabis use was statistically associated with higher average pain intensity after controlling for sociodemographic and substance use factors. As individuals continue to use cannabis, researchers should continue to assess frequency of cannabis use within the context of pain.