The Timing of Onset of Pain and Substance Use Disorders


  • The views expressed in this report are those of the authors and do not necessarily represent those of the VA. Address correspondence to Dr. Ilgen, 4250 Plymouth Road, Ann Arbor, MI 48109-5763. E-mail:


Using data from the National Comorbidity Survey—Replication, this study examined the timing of onset of self-report comorbid chronic nonarthritis pain and substance use disorders (SUDs) and characteristics associated with different onset patterns. Most individuals (58.2%; N = 351/632) report that the SUD preceded the onset of pain. Relative to those with SUDs prior to the onset of chronic pain, those experiencing pain first were less likely to have a drug use disorder, more likely to have head pain, to be younger at the onset of the first condition, and to have a shorter duration between condition onsets. (Am J Addict 2010;00:1–7)