ORIGINAL RESEARCH article
Front. Pain Res.
Sec. Pediatric Pain
Associations between COVID-19 Impact and Subsequent Substance Use in Adolescents with Chronic Pain
Provisionally accepted
Bridget A. Nestor1,2
Camila Koike1
Kimberly Pokstis1
Nicole Tacugue1Jack Dandaraw2Kristina Wright2Christine Greco1
Elissa W. Weitzman1
Lydia A. Shrier1
Joe Kossowsky1*- 1Boston Children's Hospital, Harvard Medical School, Boston, United States
- 2Endicott College, Beverly, United States
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Objective: The current cross-sectional study retrospectively investigated associations between COVID-19-related factors and subsequent substance use in adolescents with chronic pain. Methods: 243 adolescents with diagnosed pain disorders were retrospectively surveyed from September 2021 to May 2024. Descriptive statistics summarized Past-Month and Past-Year substance use, COVID-19 Exposures, Impact, and Distress, mental health, and pain-related indicators. Logistic regressions estimated odds of substance use based on COVID-19 exposures, impact, and distress, controlling for demographics, mental health, and pain. Results: Of 243 adolescents (Mage=16.9, SD=1.42 years; 68.44% female), 39.9% reported Past-Year substance use and 28.4% reported Past-Month substance use. All participants reported COVID-19 Exposures (M=9.68, SD=3.53), Impact (34.00, SD=10.11) and Distress (M=5.25, SD=2.19). No differences in Exposures or Distress emerged between youth with versus without substance use (ps>.05). Youth with Past-Month (U=2522, p<.001) and Past-Year (U=3998, p<.001) substance use reported more Impact, compared to those without use. COVID-19 Social Impact predicted odds of Past-Year (OR=1.25, 95% CI=1.13-1.38) and Past-Month (OR=1.27, 95% CI=1.14-1.42) substance use, controlling for gender, anxiety, depression, stress, pain intensity, pain interference, and functional disability. Discussion: The social impact of COVID-19 uniquely predicted subsequent substance use, over and above mental and physical health symptoms in adolescents with chronic pain. Incorporating socially-focused interventions into multidisciplinary pain treatment and prevention efforts may better support the health and wellness of youth with chronic pain.
Keywords: COVID-19, adolescents, Chronic Pain, substance use, Pain
Received: 29 Aug 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 Nestor, Koike, Pokstis, Tacugue, Dandaraw, Wright, Greco, Weitzman, Shrier and Kossowsky. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Joe Kossowsky, joe.kossowsky@childrens.harvard.edu
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