“It frees your body from that pain thought”: A mixed-methods exploration of patterns, contexts, and experiences of cannabis use for pain in rural communities - 08/08/24

Doi : 10.1016/j.jpain.2024.104636

Emily Warner *, ^†, Desiree Azizoddin ^†,^‡, Summer G. Frank-Pearce ^†,^§, Lance Ford ^†, David Bradley ^†, Amy M. Cohn ^†,^¶, Michael Businelle ^†,^‡, Paul Spicer ^∥, Hannah Appleseth *, ^†, Julia McQuoid ^†,^‡,^⁎
^* Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
^† TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
^‡ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
^§ Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
^¶ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
^∥ Department of Anthropology, University of Oklahoma, Norman, Oklahoma

^⁎Address reprint requests to Julia McQuoid, PhD, TSET Health Promotion Research Center & Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 100, Oklahoma City, OK 73104.TSET Health Promotion Research Center & Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center655 Research Parkway, Suite 100Oklahoma CityOK73104

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Abstract

U.S. adults increasingly report using cannabis to manage chronic pain and rural areas have inadequate comprehensive pain management. Using mixed methods, we aimed to understand how and why some rural adults use cannabis for pain, including within the context of co-use with opioids. Participants (N = 14, Oklahoma) were rural-dwelling adults who used tobacco and ≥1 other substance, including cannabis and opioids, ≥3 days per week. Participants completed 14 days of ecological momentary assessment (EMA) regarding substance use and subsequent in-depth interviews discussing maps of their substance use reports. Half (7/14) described cannabis use for chronic pain, and most of these (85%) reported use on ≥75% of EMA days. The most frequently reported cannabis use motive was therapeutic/medicinal (90% of use reports). Most reports were of combusted cannabis (88% of use reports) at home (99% of use reports). Same-day use of cannabis and opioids was relatively common (45% of daily surveys), but seemingly not within close temporal proximity. Interview narratives characterized cannabis as modifying pain-adjacent factors (eg, thoughts), not eliminating pain itself. They recounted using a repertoire of substances to manage different pain dimensions (eg, intensity, quality) and balance perceived trade-offs of different substances. Participants described high medical cannabis access, low pain specialist access, and most physicians as unwilling to discuss cannabis for pain. The findings suggest that rural-dwelling patients could benefit from increased access to comprehensive pain management, having cannabis addressed within pain management provider discussions, and that risks and benefits of cannabis use for pain must be better established.

Perspective

This study used a geographically explicit EMA mixed method to gather rich, intensive pilot data on cannabis use and co-use for chronic pain in rural Oklahoma. It provides unique insights to inform future research on cannabis use among a vulnerable and understudied subgroup of adults with pain—rural residents.

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Highlights

•	Rural U.S. communities lack comprehensive pain management services and have high rates of pain.
•	Rural Oklahoma has these characteristics as well as high access to medical cannabis.
•	A mixed-methods study examined cannabis use and co-use for pain in rural Oklahoma.
•	Increased access to comprehensive pain management in rural areas is needed.
•	Cannabis should be addressed in patient-clinician pain management discussions in rural areas.