Why chronic pain sufferers turn to cannabis and other substances—and what helps

This study explored patient experiences with non-traumatic painful upper-extremity conditions (NPUCs) and co-occurring risky substance use and assessed perspectives on the acceptability and usability of Web-TIRELESS, an integrated web-based mind-body intervention addressing both conditions concurrently. Nineteen adults with NPUCs and risky substance use completed individual semi-structured interviews. Data were analyzed using a hybrid deductive-inductive thematic analysis approach. Four themes emerged: (1) Challenges managing pain: Patients reported functional deterioration, emotional distress, and frustration with limited symptom relief, often associated with maladaptive coping strategies, including substance use. (2) Motivations for substance use and change: Alcohol, cannabis, and tobacco were commonly used to manage pain, stress, or sleep difficulties. Participants had limited awareness of the reciprocal relationship between pain and substance use and expressed low motivation to change. (3) Intervention preferences: Web-TIRELESS was viewed positively for its flexibility, privacy, and accessibility. Participants preferred credible, evidence-based, and practical pain-coping content. (4) Barriers and facilitators: Barriers included skepticism about efficacy, low motivation, and technological accessibility. Facilitators included live-human support, streamlined content, and accountability reminders. Patients prefer flexible, accessible, and evidence-based psychosocial interventions addressing pain and substance use simultaneously. Upon integrating patient suggestions, Web-TIRELESS may effectively bridge gaps in integrated orthopedic care. Patient Experiences with Ongoing Hand, Wrist, Arm, or Shoulder Pain and Risky Substance Use, and Views on an Online Mind–Body ProgramPeople with ongoing hand, wrist, arm, or shoulder pain that is not caused by an injury often have pain that affects daily activities and emotional well-being. Many individuals use substances such as alcohol, cannabis, or tobacco to cope with pain, stress, or sleep problems, but substances can also make pain worse over time.In this study, researchers interviewed 19 adults with chronic upper-extremity pain and risky substance use. The study aimed to understand their experiences with pain and to gather feedback on an online program called Web-TIRELESS that was designed to help people manage both pain and substance use.Participants described living with significant daily pain, difficulty performing everyday tasks, emotional distress, and frustration with limited treatment options. Many reported using substances to cope with pain and related difficulties and often felt unsure about how to manage pain and distress without substances.Overall, participants were interested in Web-TIRELESS and liked that it could be completed at their own pace and in private. They especially valued practical, evidence-based strategies to help manage pain and emotional distress. However, some participants expressed skepticism about whether the program would work and were concerned about their motivation to complete it.These findings suggest that individuals with chronic upper-extremity pain and risky substance use may benefit from programs that address both issues together. Programs that explain the connection between pain and substance use, teach coping skills, and include support and encouragement may help people take part and benefit more.