Co-occurring pain-related functional limitation and tobacco/alcohol use is associated with unmet care in U.S. adults

Pain that limits daily functioning often co-occurs with tobacco and alcohol use, but population-level data on unmet treatment needs are limited. We analyzed 2022 Medical Expenditure Panel Survey data for adults ( n = 10,777). Pain-related functional limitation was defined as pain limiting normal work “moderately,” “quite a bit,” or “extremely”, and substance use was defined as tobacco use “every day” or “some days” and/or alcohol use at least monthly. We created a four-level profile (neither, pain only, substance use only, both) and used survey-weighted logistic regression to examine associations with three measures of unmet care including two household-level cost-related measures (delayed medical care due to cost and inability to afford medical care) and one person-level measure (needing counseling or treatment but not getting it). Regression models used outcome-specific complete cases. Overall, 42.6% of adults had neither pain nor substance use, 8.9% had pain only, 42.0% had substance use only, and 6.6% had both. Compared with neither, pain-only respondents had higher odds of reporting household-level delayed care due to cost (aOR [95% CI] = 1.99 [1.34, 2.95]) and inability to afford medical care (aOR [95% CI] = 2.52 [1.62, 3.93]); respondents with both pain and substance use also had elevated odds (aOR [95% CI] = 1.78 [1.22, 2.59] and aOR [95% CI] = 2.81 [1.80, 4.37], respectively). Substance use only was not associated with either household-level cost-related outcome but was associated with person-level unmet mental health treatment (aOR [95% CI] = 1.44 [1.19, 1.73]), as was the pain + substance use group (aOR [95% CI] = 1.65 [1.20, 2.26]). Adjusted pairwise contrasts showed that the co-occurrence group had higher odds than the tobacco/alcohol-use-only group for household-level delayed care (aOR [95% CI] = 1.86 [1.25, 2.76]) and inability to afford care (aOR [95% CI] = 3.26 [2.01, 5.28]), but did not differ significantly from the pain-only group for either outcome. Pain-related functional limitation, with or without tobacco/alcohol use, was associated with household-level cost-related unmet care. Tobacco/alcohol-use-only and co-occurring profiles were associated with person-level unmet mental-health treatment. The co-occurring group did not have significantly higher adjusted odds of any outcome than the pain-only group. Longitudinal studies are needed to clarify temporality and evaluate strategies for improving access to pain and behavioral healthcare. Not applicable.