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Research Article: Associations between COVID-19 impact and subsequent substance use in adolescents with chronic pain

Date Published: 2025-11-28

Abstract:
The current cross-sectional study retrospectively investigated associations between COVID-19-related factors and subsequent substance use in adolescents with chronic pain. A total of 243 adolescents with diagnosed pain disorders were retrospectively surveyed from September 2021 to May 2024. Descriptive statistics summarized past-month and past-year substance use; COVID-19 exposures, impact, and distress; mental health; and pain-related indicators. Logistic regressions estimated the odds of substance use based on COVID-19 exposures, impact, and distress, controlling for demographics, mental health, and pain. Of the 243 adolescents ( M age =?16.9, SD?=?1.42 years; 68.44% female), 39.9% reported past-year substance use, and 28.4% reported past-month substance use. All participants reported COVID-19 exposures ( M =?9.68, SD?=?3.53), impact ( M =?34.00, SD?=?10.11), and distress ( M =?5.25, SD?=?2.19). No differences in Exposures or Distress emerged between youth with vs. without substance use ( p ’s?>?0.05). Youth with past-month ( U =?2,522, p <?0.001) and past-year ( U =?3,998, p <?0.001) substance use reported more Impact, compared with those without use. COVID-19 social impact predicted odds of past-year (OR?=?1.25, 95% CI?=?1.13–1.38) and past-month (OR?=?1.27, 95% CI?=?1.14–1.42) substance use, controlling for gender, anxiety, depression, stress, pain intensity, pain interference, and functional disability. The social impact of COVID-19 uniquely predicted subsequent substance use, over and above mental and physical health symptoms in adolescents with chronic pain. Incorporating socially focused interventions into multidisciplinary pain treatment and prevention efforts may better support the health and wellness of youth with chronic pain.

Introduction:
The COVID-19 pandemic affected adolescents worldwide through school shutdowns, activity cancellations, and social distancing orders, and it was associated with significant increases in youth anxiety, depression, irritability, and anger ( 1 ). For youth with chronic pain, a condition that impacts nearly 40% of children and adolescents globally, the initial pandemic lockdown was associated with mixed effects. For example, although youth with chronic pain reported more school-related difficulties and reduced time…

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