A roadmap to understanding cannabis use and chronic pain

Chronic pain is a significant public health problem associated with substantial medical expenditures, decreased quality of life, and physical and mental health comorbidities. Substance use is an important clinical consideration in pain, as substance use has been identified as both an antecedent and consequence of chronic pain. The majority of research on substance use and chronic pain has focused on opioid use, and although commonly used, alcohol, nicotine, and cannabis have received considerably less research attention. While there are empirical studies that examine the impact of non-opioid substance use in the context of chronic pain, the overall prevalence rates of nicotine, alcohol, and cannabis use disorders among adults with chronic pain have not been well-documented. Therefore, a systematic review and meta-analysis that characterizes the prevalence rates of non-opioid substance use disorders among adults with chronic pain is urgently needed. The current paper outlines the protocol for a systematic review and meta-analysis. It will include studies of adults with chronic pain that report on nicotine, alcohol, or cannabis use disorders, as well as problematic use (including co-use where available). The following databases will be searched: PubMed, Embase (Elsevier), Web of Science Core Collection, CINAHL (EBSCO), and PsycINFO (EBSCO). A team of trained research staff will conduct study screening and data extraction. Analyses will focus on pooled prevalence estimates of substance use disorders as primary outcomes and problematic use as secondary outcomes, with planned sub-group analyses and strategies to mitigate potential sources of bias. The results of this review will provide valuable clinical information on the scope of non-opioid substance use disorders, helping to guide future research as well as inform clinical and policy-level decision making.