Substance use disorders in outpatients with bipolar disorder and pain complaints.
Journal of Affective Disorders. 2025-11-01; 389: 119693
DOI: 10.1016/j.jad.2025.119693
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https://www.bordeaux-neurocampus.fr/11664
Chabert J(1), Icick R(2), Cabé J(3), Moisset X(4), Godin O(5), Gard S(6),
Aouizerate B(7), Loftus J(8), Aubin V(9), Lefrere A(10), Dubertret C(11), Roux
P(12), Polosan M(13), Schwitzer T(14), Etain B(2), Moirand R(15), Olié E(16),
Haffen E(17), Leboyer M(18), Courtet P(19), Walter M(20), Bouaziz N(21), Yrondi
A(22), Belzeaux R(23); Bipolar-Addiction workgroup(24); FACE-BD collaborators;
Llorca PM(25), Brousse G(26), Samalin L(25).
Author information:
(1)Service d’Addictologie et de Pathologies duelles, CHU Clermont-Ferrand,
Université Clermont-Auvergne, CNRS, Clermont-Auvergne INP, Institut Pascal
(UMR6602), 58 rue Montalembert, 63003 Clermont-Ferrand, France. Electronic
address: .
(2)FondaMental Foundation, Créteil F-94000, France; AP-HP Nord, GHU
Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Hôpital
Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, Paris
F-75010, France; INSERM UMRS 1144 Optimisation Thérapeutique en
Neuropsychopharmacologie, Université de Paris Cité, Paris F-75006, France.
(3)Service d’Addictologie et de Pathologies duelles, CHU Clermont-Ferrand,
Université Clermont-Auvergne, CNRS, Clermont-Auvergne INP, Institut Pascal
(UMR6602), 58 rue Montalembert, 63003 Clermont-Ferrand, France.
(4)Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol,
F-63000 Clermont-Ferrand, France.
(5)FondaMental Foundation, Créteil F-94000, France; Université Paris Est Créteil
(UPEC), INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil,
France.
(6)FondaMental Foundation, Créteil F-94000, France; Hospital Charles Perrens,
Department of General and Academic Psychiatry, Bordeaux F-33076, France.
(7)FondaMental Foundation, Créteil F-94000, France; Hospital Charles Perrens,
Department of General and Academic Psychiatry, Laboratory NutriNeuro (INRAE UMR
1286), University of Bordeaux, Bordeaux F-33076, France.
(8)FondaMental Foundation, Créteil F-94000, France; INSERM UMRS 1144
Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris
Cité, Paris F-75006, France.
(9)FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Center
Hospitalier Princesse Grace, Monaco.
(10)FondaMental Foundation, Créteil F-94000, France; Assistance Publique
Hôpitaux de Marseille, INT-UMR7289, Aix-Marseille Université, Marseille, France.
(11)FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM
UMR1266, Hôpital Louis Mourier, Colombes, France.
(12)FondaMental Foundation, Créteil F-94000, France; Centre Hospitalier de
Versailles, Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Le
Chesnay, France; Université Paris-Saclay, Université de Versailles
Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France.
(13)FondaMental Foundation, Créteil F-94000, France; Univ. Grenoble Alpes, CHU
de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U
1216, Grenoble, France.
(14)FondaMental Foundation, Créteil F-94000, France; Centre Psychothérapique de
Nancy, CPN, Laxou, France.
(15)FondaMental Foundation, Créteil F-94000, France; INSERM U1028-CNRS
UMR5292-University Lyon 1, Villeurbanne F-69000, France; ΨR2 Team, Centre
Hospitalier Le Vinatier, F-69678, France.
(16)FondaMental Foundation, Créteil F-94000, France; Department of Emergency
Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France;
Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM,
Montpellier, France.
(17)CIC-1431 INSERM, CHU de Besançon, Besançon, France.
(18)FondaMental Foundation, Créteil F-94000, France; Hôpitaux Universitaires
Henri Mondor, Université Paris Est Créteil, INSERM U955, F-94010, France.
(19)FondaMental Foundation, Créteil F-94000, France; Department of Emergency
Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France.
(20)FondaMental Foundation, Créteil F-94000, France; Service
Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho
Sociale 29G01 et 29G02, CHRU de Brest, Hôpital de Bohars, Brest, France.
(21)FondaMental Foundation, Créteil F-94000, France; Pôle universitaire 93G03
EPS ville Evrard, Neuilly-sur-Marne, France.
(22)Department of Psychiatry, Toulouse University Hospital (CHU), Treatment
Resistant Depression Expert Center, FondaMental Toulouse, France.
(23)FondaMental Foundation, Créteil F-94000, France; Pôle Universitaire de
Psychiatrie, CHU de Montpellier, 39 Avenue C. Flahaut, 34090 Montpellier,
France.
(24)FondaMental Foundation, Créteil F-94000, France.
(25)FondaMental Foundation, Créteil F-94000, France; Service de Psychiatrie
Adulte, CHU Clermont-Ferrand, Université Clermont-Auvergne, CNRS,
Clermont-Auvergne INP, Institut Pascal (UMR6602), 58 rue Montalembert, 63003
Clermont-Ferrand, France.
(26)Service d’Addictologie et de Pathologies duelles, CHU Clermont-Ferrand,
Université Clermont-Auvergne, CNRS, Clermont-Auvergne INP, Institut Pascal
(UMR6602), 58 rue Montalembert, 63003 Clermont-Ferrand, France; FondaMental
Foundation, Créteil F-94000, France.
INTRODUCTION: Pain and substance use disorders (SUDs) are common in bipolar
disorder (BD), yet the associations between these comorbid conditions are poorly
understood. Our hypotheses were: (1) the frequency of SUDs may vary according to
pain intensity in individuals with BD, (2) individuals with BD, pain and SUDs
may have specific characteristics, and (3) clinical variables could explain the
associations between pain and SUDs.
METHOD: We included outpatients from the FACE-BD cohort with a lifetime
diagnosis of BD type I or II. Current pain was categorized using one item of the
EQ-5D-5L scale as « no pain », « mild pain », « moderate pain », and « severe or
extreme pain ». Associations between pain level and other variables were tested
using bivariate analyses, while multiple regression was conducted to
characterize individuals with BD, pain and relevant SUDs. Finally, path analysis
was performed to examine whether clinical variables could explain the
associations between pain and relevant SUDs.
RESULTS: Among the 1897 BD participants, 927 reported any pain (48.9 %). Among
SUDs, higher pain levels were only associated with a history of lifetime alcohol
use disorder (AUD). Only individuals with both AUD and moderate to extreme pain
had a greater risk of having a history of lifetime anxiety disorder and panic
disorder. In path analysis, the association between lifetime AUD and pain was
partly mediated by current levels of depression, anxiety, and affective
lability.
CONCLUSION: Our study highlights multiple associations in individuals with BD
between the intensity of reported pain and history of lifetime AUD.
Copyright © 2025. Published by Elsevier B.V.
DOI: 10.1016/j.jad.2025.119693
PMID: 40553735
Conflict of interest statement: Declaration of competing interest Over the past
five years, RI has received fringe benefits corresponding to ten meals
surrounding presentations from CAMURUS SAS about buprenorphine and methadone
treatment. BE served as a consultant for Sanofi. The other authors declare no
conflict of interest with this study.