The association between physical pain and cannabis use in daily life: An experience sampling method

Smartphone App–Based Noncontact Ecological Momentary Assessment With Experienced and Naïve Older Participants: Feasibility Study

Background

Smartphone app–based ecological momentary assessment (EMA) without face-to-face contact between researcher and participant (app-based noncontact EMA) potentially provides a valuable data collection tool when geographic, time, and situational factors (eg, COVID-19 restrictions) place constraints on in-person research. Nevertheless, little is known about the feasibility of this method, particularly in older and naïve EMA participants.

Objective

This study aims to assess the feasibility of app-based noncontact EMA as a function of previous EMA experience, by recruiting and comparing a group of participants who had never participated in EMA before against a group of participants who had been part of an earlier in-person EMA study, and age, by recruiting middle-aged to older adults.

Methods

Overall, 151 potential participants were invited via email; 46.4% (70/151) enrolled in the study by completing the baseline questionnaire set and were emailed instructions for the EMA phase. Of these participants, 67% (47/70) downloaded an EMA app and ran the survey sequence for 1 week. In total, 5 daytime surveys and 1 evening survey, each day, assessed participants’ listening environment, social activity, and conversational engagement. A semistructured exit telephone interview probed the acceptability of the method. As markers of feasibility, we assessed the enrollment rate, study completion rate, reason for noncompletion, EMA survey response rate, and likelihood of reporting an issue with survey alerts and requested assistance from researchers, family, or friends.

Results

Enrollment rates among invitees (63.3% vs 38.2%; P=.004) and completion rates among enrollees (83.9% vs 53.8%; P<.001) were higher in the experienced than in the naïve EMA group. On average, experienced participants responded to 64.1% (SD 30.2%) of the daytime EMA surveys, and naïve participants responded to 54.3% (SD 29.5%) of the daytime EMA surveys (P=.27). Among participants who retrospectively reported issues with survey alerts, only 19% (3/16) requested researcher assistance during data collection. Older participants were more likely to report not being alerted to EMA surveys (P=.008), but age was unrelated to all other markers of feasibility. Post hoc analyses of the effect of the phone operating system on markers of feasibility revealed that response rates were higher among iOS users (mean 74.8%, SD 20.25%) than among Android users (mean 48.5%, SD 31.35%; P=.002).

Conclusions

Smartphone app–based noncontact EMA appears to be feasible, although participants with previous EMA experience, younger participants, and iOS users performed better on certain markers of feasibility. Measures to increase feasibility may include extensive testing of the app with different phone types, encouraging participants to seek timely assistance for any issues experienced, and recruiting participants who have some previous EMA experience where possible. The limitations of this study include participants’ varying levels of existing relationship with the researcher and the implications of collecting data during the COVID-19 social restrictions.

Medical Cannabis Use and Pain: An Experience Sampling Study

Background: Little research has tested associations of pain and MC use after long-term treatment and through methods that have external validity outside experimental settings. The study examined associations of pain, associated painful experiences, and long-term medical cannabis (MC) use in chronic pain (CP) patients using a naturalistic daily diary study that provided novel and externally valid data. Methods: Data were obtained from 78 MC users with CP three times daily over a 10-day period (n_observations = 1,688). Mixed-effects models were used to test the associations between MC use and momentary experiences of pain, affect, and fatigue. Results: Within persons, elevated experiences of pain intensity were associated with greater intention to use MC within the next hour. No evidence was found that the time lapse since last MC use was associated with pain levels, negative affect, or fatigue. Conclusions: The results imply that after long-term use, CP patients intend to use MC in response to pain experiences. Yet, they may not actually achieve the pain relief. More research is needed to examine whether continued MC use despite lack of pain relief is related to relief of other symptoms (e.g., dependence, withdrawal) or positive benefits (e.g., general sense of well-being) or tolerance.

Real-time associations between young adults' momentary pain and prescription opioid misuse intentions in daily life

Managing pain has been identified (mainly through retrospective reports) as a robust motivator for individuals engaging in prescription opioid misuse. However, surprisingly little work has directly examined whether momentary pain experiences are associated with prescription opioid misuse in daily life. Participants included 297 young-adult college students recruited on the basis of recent prescription drug misuse. Ecological momentary assessment over a 28-day period was utilized to collect participants' pain experiences and prescription opioid misuse intention and behavior. Hierarchical generalized linear modeling and binary logistic regression tested hypotheses. Findings revealed that higher in-the-moment pain was positively associated with intentions to engage in prescription opioid misuse, accounting for report timing and participant sex and background substance use. Also, the between-person result indicated that participants who reported higher levels of pain across the reporting period were more likely to intend to misuse prescription opioids in daily life. There was a similar reliable association between higher pain ratings across the reporting period and greater likelihood of engaging in misuse behavior, although actual misuse frequency was low. Reliable moderation was observed: As hypothesized, the within-person association between momentary pain and misuse intentions was stronger for females compared with males. Also, the within-person link between pain and misuse intentions was stronger for those who reported lower (vs. higher) levels of problematic alcohol use; this was not consistent with the hypothesized direction. Understanding the role of college students' pain in their intentions to engage in prescription opioid misuse is important for informing future research and prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cannabis Use among Dual Electronic and Combustible Cigarette Smokers: Relations with Pain and Hazardous Drinking

Background: E-cigarette use is on the rise and many adult e-cigarette users also smoke combustible cigarettes. Past work suggests that dual use (i.e. use of both electronic and combustible cigarettes) is associated with greater rates of cannabis use, yet little is known about the nature of cannabis use among dual users. Objectives: The current study examined 414 adult dual users (48.3% female, M_age = 35.1 years), half of whom endorsed current (past month) cannabis use. Results: Results indicated that cannabis users reported more severe pain, greater pain interference, and more hazardous drinking. In addition, cannabis use was robustly related to hazardous drinking after statistically controlling for demographic and pain-related variables. Cannabis use was also associated with hazardous drinking indirectly via pain interference at greater levels of pain severity. Conclusions/Importance: These results highlight several clinical correlates of cannabis use among adult dual users, and also suggest that pain may play an important role in hazardous drinking among these individuals.

Autonomy level and quality of everyday experience of people with Hereditary Spastic Paraplegia

In the health domain, well-being is primarily assessed as autonomy and mental distress, whereas the quality of daily experience is rarely investigated. In this study, the relationship between autonomy levels and daily experience was explored. Thirty-five Italian adults with Hereditary Spastic Paraplegia provided for one week real-time descriptions of daily activities and associated experiences through the Experience Sampling Method procedure. Participants were grouped based on autonomy levels assessed through Barthel Index. The relationships between activity typologies, the experiential dimensions, perceived challenges and skills, and autonomy level were analysed. Participants' predominant activities were personal care, associated with global disengagement, and leisure, associated with high control and desirability, but low perceived relevance. During social interactions participants reported engagement and emotional well-being, and during productive activities high activation but negative affect. Multi-level analysis highlighted that this association between activity type and experiential patterns recurred across autonomy levels. In addition, perceived challenges in the activity were lower that perceived personal skills across activities and autonomy levels. Findings suggest that persons with motor disabilities, regardless of their autonomy level, would benefit from more challenging opportunities for action in daily life, in order to attain well-being through active skill mobilisation.