20 November 2023

Prolonged use of painkillers in youth led to mental illness in adulthood

People who took painkillers for long periods before the age of 25 have an increased risk of poorer mental health later in life. This is the conclusion reached by researchers from the University of Liverpool and St. George's University of London (both in the UK).

If pain lasts for more than three months, it is considered chronic. While it makes intuitive sense that it could increase the risk of mental illness, a new study has confirmed this link. Pain is unpleasant on its own, and when it is severe, it can lead to complete disability. In addition, conditions that cause pain are often stigmatized, which also hits the psyche. From this perspective, chronic pain can be seen as prolonged or repeated exposure to stress and adversity, which are closely linked to mental health. 

Chronic pain is more common in adults. But according to epidemiologic studies, chronic and recurrent pain affects about a quarter of children, and 8% report intense and frequent pain. The long-term effects of this in childhood are unclear. 

Medications used to relieve pain can also pose a risk, especially in the case of opioids. For example, researchers found that using opioids (prescription) before high school led to their use between the ages of 19 and 23, no longer for medical purposes.

Now, the scientists investigated how common opioid analgesic use was in children and young adults, and whether it could be related to or independent of an underlying chronic pain condition. They also sought to find out whether exposure to chronic pain and medications was associated with chronic lifelong use of prescription opioid medications or with adverse effects of substance abuse and poor mental health. The results are published in the Lancet Regional Health - Europe.

Researchers conducted the cohort study using data from IQVIA Medical Research Data UK, a database consisting of longitudinally linked, anonymized medical records from more than 500 participating primary care sites in the UK. 

In total, the researchers studied the health of 853,625 children and young people aged two to 24 years. Of these, 115,101 were diagnosed with chronic pain syndrome, 20,298 had a repeat prescription for painkillers, and 11,032 were diagnosed with chronic pain syndrome and prescribed painkillers.

After reaching age 25, participants were followed for an average of five years. A total of 11,644 were diagnosed with substance abuse, 143,838 had poor mental health, and 77,337 received at least one prescription for opioids during follow-up.

As a result, the researchers found that children and young adults under the age of 25 who had chronic pain were 29% more likely to develop mental illness in adulthood. Those who had chronic pain and received prescription painkillers had a 46% higher risk of developing mental illness in adulthood and an 82% higher risk of substance abuse.

In addition, having a diagnosis of chronic pain and being prescribed a painkiller at a young age led to more frequent use of prescription opioids in later life. 

The researchers acknowledged that the trends found in the study could be due to multiple factors. However, they are still a concern because people under the age of 25 are particularly vulnerable.

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