Associations Between Pain and Substance Use Among Individuals Diagnosed with Ehlers-Danlos Syndromes or Generalized Hypermobility Spectrum Disorder

Callon M Williams^{1

2}, Molly McCarthy^{3

4}, Michelle Flynn^{3

4}, Rachel Siegal^{3

4}, Stephanie Buryk-Iggers^{3

4}, Keisha C Gobin^{5

6}, Dmitry Rozenberg^{4

7}, Max Rachinsky⁴, Praveen Ganty^{3

4}, Laura McGillis⁴, Nimish Mittal^{3

4

8

9}, Tania Di Renna⁴, Joel Katz^{3

4

10

11

12}, Hance Clarke^{3

4

11

12}, P Maxwell Slepian^{13

14

15

16}

Affiliations

¹ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada. callon.williams@uhn.ca.
² GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada. callon.williams@uhn.ca.
³ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada.
⁴ GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada.
⁵ Chronic Pain Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada.
⁶ Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Canada.
⁷ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, Canada.
⁸ Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
⁹ Temerty Faculty of Medicine, Department of Medicine, Division of PM&R, University of Toronto, Toronto, Canada.
¹⁰ Department of Psychology, York University, Toronto, Canada.
¹¹ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
¹² University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada.
¹³ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁴ GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁵ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁶ University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada. maxwell.slepian@uhn.ca.

PMID: 41219584
DOI: 10.1007/s12529-025-10409-3

Associations Between Pain and Substance Use Among Individuals Diagnosed with Ehlers-Danlos Syndromes or Generalized Hypermobility Spectrum Disorder

Callon M Williams et al. Int J Behav Med. 2025.

. 2025 Nov 11.

doi: 10.1007/s12529-025-10409-3. Online ahead of print.

Authors

Affiliations

¹ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada. callon.williams@uhn.ca.
² GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada. callon.williams@uhn.ca.
³ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada.
⁴ GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada.
⁵ Chronic Pain Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada.
⁶ Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Canada.
⁷ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, Canada.
⁸ Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
⁹ Temerty Faculty of Medicine, Department of Medicine, Division of PM&R, University of Toronto, Toronto, Canada.
¹⁰ Department of Psychology, York University, Toronto, Canada.
¹¹ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
¹² University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada.
¹³ Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁴ GoodHope Ehlers-Danlos Syndrome Clinic, University Health Network, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁵ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada. maxwell.slepian@uhn.ca.
¹⁶ University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada. maxwell.slepian@uhn.ca.

PMID: 41219584
DOI: 10.1007/s12529-025-10409-3

Abstract

Background: Pain and substance use frequently co-occur. Research indicates pain motivates alcohol, cannabis, and tobacco use. Pain is also highly co-morbid with Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorder (G-HSD), however, research on pain and substance use in these populations remains limited.

Methods: Descriptive, cross-sectional, retrospective chart review was conducted of 533 patients (89% female) seen at the GoodHope EDS Clinic at Toronto General Hospital and diagnosed with EDS or G-HSD. Patients provided self-report data on pain and substance use. Analyses included descriptive statistics and bivariate correlations.

Results: Half of the sample reported clinically significant pain severity (55%) and interference (57%). Alcohol use was reported by half of the sample (59%) and 18% reported prescription opioid use. Cannabis use was reported by 48%, with 69% using ≥ 4 times per week. Patients who used cigarettes (14%) smoked a median of 8.0 cigarettes per day (IQR = 4.0-12.0). Pain severity and interference were positively associated with cannabis use frequency, quantity, opioid use, and cigarette use (ρ = .13 - .28, ps < .05), and negatively associated with alcohol use (ρ = -.20 and -.20, ps < .05).

Conclusions: Greater pain severity and interference were associated with greater cannabis and cigarette use, but lower alcohol use. Longitudinal studies are needed to determine if pain is a motivator for cannabis/cigarette use and/or if persistent use exacerbates pain in this population. Research should also examine if negative associations between pain and alcohol use reflect alcohol analgesia (i.e., lower pain at greater drinking) or avoidance due to the exacerbation of co-occurring conditions with EDS/G-HSD.

Keywords: Alcohol; Cannabis; Ehlers-Danlos Syndromes; Pain; Tobacco.

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Conflict of interest statement

Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This research was approved by the Research Ethics Board (REB) of the University Health Network (REB# 18-5850). Informed Consent: Formal consent is not required for this type of study. Conflict of interest: The authors declare no competing interests.

References

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Associations Between Pain and Substance Use Among Individuals Diagnosed with Ehlers-Danlos Syndromes or Generalized Hypermobility Spectrum Disorder

Affiliations

Associations Between Pain and Substance Use Among Individuals Diagnosed with Ehlers-Danlos Syndromes or Generalized Hypermobility Spectrum Disorder

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

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