Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.

中文翻译：

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疼痛和物质使用的互惠模型：诊断诊断，临床意义和未来方向。

疼痛和物质使用是高度普遍且同时发生的疾病，继续引起越来越多的临床和经验兴趣。尽管尼古丁和烟草，酒精和大麻各自具有急性镇痛作用，但频繁或大量使用可能会导致慢性疼痛的发生和发展，并且在禁欲期间疼痛可能会加剧。此外，疼痛可能是药物自我管理的有效诱因，并且可能导致药物使用逐步增加以及与药物相关的治疗效果较差。我们综合了各种证据，提出了一个相互的模型，其中假设疼痛和物质使用以正反馈回路的方式相互作用，从而随着时间的推移加剧和维持这两种情况。回顾了双向疼痛物质使用关系中的理论机制，包括负强化，社会认知过程和重叠神经回路中的同构负荷。最后，确定候选的转诊因素，并以对临床意义和未来研究方向的讨论作为结束。