Emotion dysregulation may explain why cannabis problems lead to worse mental health in chronic pain patients | Research

The takeaway

Among 431 adults with chronic pain, cannabis use problems were linked to worse anxiety, depression, and suicidal ideation, with emotion dysregulation explaining much of these relationships.

Pain psychologists, addiction counselors, and clinicians treating chronic pain patients who use cannabis.

Emotion dysregulation mediated cannabis-mental health link for all three outcomes

What the researchers found

In 431 opioid-using adults with moderate to severe chronic pain (176 current cannabis users, 30% with cannabis use problems), emotion dysregulation significantly mediated the relationship between cannabis use problems and anxiety, depression, and suicidal ideation. The indirect effects through emotion dysregulation were significant for all three outcomes.

Why it matters

Many chronic pain patients use cannabis, but those who develop problematic use patterns may have worse mental health. Understanding that emotion dysregulation is the connecting mechanism suggests a treatment target.

The numbers in context

431 participants; 176 current cannabis users; 30.2% with cannabis use problems; significant indirect effects via emotion dysregulation for anxiety, depression, and suicidal ideation.

How the study worked

Cross-sectional mediation analysis in 431 opioid-using adults with chronic pain, testing whether emotion dysregulation explained relationships between cannabis use problems and anxiety, depression, and suicidal ideation.

What this study cannot tell us

Cross-sectional (cannot establish temporal order); opioid-using sample may not represent all chronic pain patients; self-report measures; mediational design assumes causal ordering that may be reversed.

How to read the evidence

Moderate: reasonable sample with mediation analysis, but cross-sectional and self-report.

When this study was published

Published 2020.

The bigger picture

This suggests that treating emotion regulation skills in chronic pain patients who use cannabis could simultaneously improve mental health outcomes and reduce problematic cannabis use.

Questions still open

Would emotion regulation therapy improve outcomes for chronic pain patients with cannabis use problems? Does cannabis use cause emotion dysregulation or do those with pre-existing dysregulation develop cannabis problems?

Common questions

Why do cannabis problems worsen mental health in chronic pain patients?

This study found emotion dysregulation, the inability to effectively manage negative emotions, explained much of the link between cannabis use problems and anxiety, depression, and suicidal ideation.

Does this mean cannabis is bad for chronic pain patients?

Not necessarily. Cannabis use itself was not the focus; rather, it was problematic cannabis use patterns. The findings suggest that difficulty regulating emotions, not cannabis per se, is the key factor linking problematic use to poor mental health.

Read the original research

Is there a relationship between cannabis use problems, emotion dysregulation, and mental health problems among adults with chronic pain?

Psychology, health & medicine, 25(6), 742-755

View on PubMed ↗Publisher’s paper ↗

Citation

Orr, Michael F; Rogers, Andrew H; Shepherd, Justin M; Buckner, Julia D; Ditre, Joseph W; Bakhshaie, Jafar; Zvolensky, Michael J. (2020). Is there a relationship between cannabis use problems, emotion dysregulation, and mental health problems among adults with chronic pain?. Psychology, health & medicine, 25(6), 742-755. https://doi.org/10.1080/13548506.2019.1653485