Recent research published in The Lancet Regional Health – Europe suggests that long-term painkiller use in early years may contribute to an increased risk of poor mental health in adulthood.
Individuals under 25 years old who have chronic pain have been found to be 29% more likely to have a mental illness in later life. However, the study suggests that those with chronic pain who were also given a prescription painkiller are 46% more likely to have a mental illness in adult hood, as well as an 82% higher risk of substance misuse.
Having a chronic pain diagnosis and being given a prescription painkiller at a young age was also linked to more prescription opioid use in later life, highlighting the importance of pain management and exploring other effective treatments when treating chronic pain.
Children and young people who were repeatedly prescribed painkillers for chronic pain were also found to exhibit a greater rate of mental illness, substance misuse and prescription opioid use in adulthood, compared to those who did not receive painkillers for their pain.
Professor Reecha Sofat, Associate Director of the BHF Data Science Centre and Breckenridge Chair of Clinical Pharmacology and Therapeutics at the University of Liverpool, said:
“These trends are concerning as under 25s are particularly vulnerable. This means a regular use of painkillers to ease chronic pain may lead to an unintentional over-reliance on pain medication in adult life. Exploring when the right time is to refer these young people to specialised pain services for more targeted support will also be a vital factor when revamping pain management practice.”
Chronic pain is a common cause of long-term disability and 8% of children experience intense and frequent pain. However, the majority of research investigating chronic pain and long-term painkiller use has focussed on adults. There is also a major gap when it comes to understanding how long-term pain medication use impacts children and young adults living with chronic pain.
The study analysed anonymised electronic health records (EHRs) of 853,625 individuals between the ages of 1 and 24, including 115,101 diagnosed with chronic pain, 20,298 given a repeat painkiller prescription and 11,032 diagnosed with chronic pain as well as prescribed painkillers.
By following up for an average of five years after the age of 25, they identified that 11,644 people experienced a substance misuse event in later life, 143,838 were noted as having poor mental health and 77,337 were prescribed at least one opioid treatment.
Dr Andrew Lambarth, Academic Clinical Fellow in Clinical Pharmacology and Therapeutics at St George’s, University of London said:
“It’s clear that chronic pain management in young people needs to be optimised. We know under treating pain can cause harm in both the short- and long-term, but it’s also essential to avoid over-reliance on medicines that could lead to dependence on prescription or non-prescription drugs in later life.
“We now need to work with all health care providers to help them weigh-up the risks and benefits of prescribing painkillers at a young age, and encourage the consideration of other recognised and effective non-drug management approaches.”
The researchers acknowledge that these findings may be influenced by various factors, such as young people who received painkillers may have experienced more severe or frequent pain, indicating a different cause, and the tendency to seek-out a prescription of painkillers.
An overrepresentation of young people with intellectual disability and autism spectrum disorder was also found among participants receiving repeat prescriptions for pain relief in the absence of a chronic pain diagnosis, suggesting potential overprescribing in this vulnerable group.
This research was supported by funding from UCLH Charity, UKRI, Versus Arthritis (via the Consortium Against Pain InEquality (CAPE): The Impact of Adverse Childhood Experiences on Chronic Pain and Responses to Treatment), and Wellcome Trust.
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