An evaluation of pain-related anxiety among daily cigarette smokers in terms of negative and positive reinforcement smoking outcome expectancies

Temporal associations between use of psychoactive substances and somatic symptoms in the daily lives of people with fibromyalgia

OBJECTIVE

Consumption of psychoactive substances-alcohol, nicotine, caffeine, opioids, and cannabis-is common among people with fibromyalgia. Associations between the use of substances and somatic symptoms could reflect efforts to cope with symptoms, aggravation or alleviation of symptoms after the use of substances, or a combination of these. To date, no study has provided insight into temporal associations between the consumption of psychoactive substances and fluctuations in somatic symptoms. We explored whether changes in ratings of pain and fatigue (mental and physical) predicted the later use of psychoactive substances or vice versa (substance use predicting later change in symptoms).

DESIGN

Micro-longitudinal design.

SETTING/SUBJECTS

Fifty adults (88% female, 86% White, mean age of 44.9 years) with fibromyalgia.

METHODS

Participants completed ecological momentary assessments of substance use, pain intensity, and physical/mental fatigue 5 times per day for 8 days.

RESULTS

Results of multilevel models indicated that momentary increases in fatigue showed a consistent association with greater odds of later use of psychoactive substances, whereas momentary increases in pain were related to lower odds of later cannabis and nicotine use and higher odds of later alcohol use. Only nicotine use predicted later mental fatigue.

CONCLUSION

Findings highlight the importance of individualized interventions for symptom management or problems related to the use of psychoactive substances. We observed that although somatic symptoms predicted later use of substances, use of substances did not show appreciable effects with regard to alleviating somatic symptoms in people with fibromyalgia.

Do Pain-Related Anxiety and Difficulties With Emotion Regulation Impact Abstinence Expectancies or Motivation to Quit E-Cigarette Use?

OBJECTIVE

Pain-related anxiety is a psychologically based construct that is associated with tobacco dependence and may have important relevance to e-cigarette use. Difficulties with emotion regulation, a relevant construct in motives for cigarette smoking, may interact with pain-related anxiety to yield worsened clinical outcomes among e-cigarette users. We evaluated whether pain-related anxiety and difficulties with emotion regulation independently and in interaction predict e-cigarette users' expectancies surrounding abstinence and their motivation to stop using e-cigarettes.

METHOD

Daily e-cigarette users (n = 290, mean age= 35.5, SD = 10.9, 56.6% male) completed an online survey about e-cigarette use. We conducted hierarchical multiple regression analyses to evaluate the main and interactive influence of pain-related anxiety and difficulties with emotion regulation on our outcomes.

RESULTS

Increased pain-related anxiety independently predicted negative abstinence expectancies and increased motivation to quit e-cigarette use (ps < .001). Increased difficulties with emotion regulation predicted only negative abstinence expectancies (ps < .01) when pain-related anxiety was included in the model. The interaction between pain-related anxiety and difficulties with emotion regulation was not significant.

CONCLUSIONS

As hypothesized, increased pain-related anxiety was associated with both negative expectancies of abstinence and increased motivation to quit e-cigarette use, but contrary to our hypothesis, difficulties with emotion regulation were not significantly associated with increased motivation to quit e-cigarette use when evaluated with pain-related anxiety in the model. These findings may elucidate processes influencing abstinence expectancies and motivation to quit in a sample of e-cigarette users, although replication in a larger, more diverse sample is warranted.

Perceived Pain and Smoking Interrelations and Expectancies Are Associated With Pain and Smoking Cessation in Individuals With Mobility Impairments

INTRODUCTION

Smoking and pain are highly prevalent among individuals with mobility impairments (MIs; use assistive devices to ambulate). The role of pain-related smoking motives and expectancies in smoking cessation is unknown. We examined cross-sectional and prospective associations between a novel measure of pain-related smoking motives (how smokers with pain perceive their pain and smoking to be interrelated) and pain and smoking behavior in smokers with MI.

METHODS

This is a secondary data analysis of a smoking cessation induction trial (N = 263; 55% female) in smokers with MI. Participants did not have to want to quit to enroll. Pain-related smoking motives and expectancies were assessed at baseline with the pain and smoking inventory (PSI) which measures perceived pain and smoking interrelations in three distinct but related domains (smoking to cope with pain, pain as a motivator of smoking and as a barrier to cessation). Other measures included pain occurrence and interference, nicotine dependence, motivation and self-efficacy to quit smoking, and number of cigarettes per day. Biochemically verified smoking abstinence was assessed at 6 months.

RESULTS

PSI scores were significantly higher among smokers with chronic pain occurrence compared to occasional and to no occurrence (p < .002) and were associated with greater pain interference (ps < .01) and lower self-efficacy to quit smoking (ps < .01). In prospective analyses adjusted for age, treatment group, and chronic pain, only expectancies of smoking to help cope with pain predicted lower odds of abstinence.

CONCLUSIONS

Targeting expectancies of smoking as a mechanism to cope with pain may be useful in increasing smoking cessation in pain populations.

IMPLICATIONS

Individuals with MI have a high prevalence of smoking and pain, yet the extent to which this population perceives pain and smoking to be interrelated is unknown. This is the first article to examine prospective associations between a novel measure of perceived pain and smoking interrelations (PSI) and smoking outcomes. The PSI was associated with greater pain and lower self-efficacy for quitting. Prospectively, the PSI subscale tapping into expectancies that smoking help coping with pain predicted a lower probability of smoking abstinence. In smokers with MI, expectancies of smoking as pain-coping mechanism may be an important clinical target.

Identifying mechanisms that link pain to smoking relapse during a quit attempt

OBJECTIVE

Emerging evidence suggests that adults with chronic pain have poor smoking cessation outcomes, but the exact mechanisms are less understood. This study examined whether depression, anxiety, stress, and then, positive outcome expectancy for smoking mediated the association between pain and smoking relapse during a quit attempt.

METHODS

This study is a secondary data analysis of a three-armed randomized clinical trial that compared in-person and smartphone-based smoking cessation interventions. Participants (N = 81) self-reported the amount of bodily pain they experienced in the past 4 weeks at baseline. Depression, anxiety, stress, and positive outcome expectancy for smoking were measured daily, via a smartphone app, throughout the first week of the quit attempt, and were aggregated to the week level for analyses. Biochemically verified smoking abstinence was assessed 4 weeks postquit date.

RESULTS

Sequential mediation analyses showed that pain was indirectly associated with smoking relapse through greater feelings of stress and then higher expectations that smoking would improve mood (B = 0.22 [95% CI = 0.03, 0.65]). The pathways for depression and anxiety were not significant mediators of pain and smoking relapse.

CONCLUSION

Findings from this study indicate that pain is indirectly associated with smoking relapse through feelings of stress and then positive outcome expectancy for smoking. Smoking cessation treatment for adults who experience high levels of bodily pain should include psychoeducation that teaches adaptive coping responses, such as mindfulness, to manage stress, and challenge expectations about the ability of smoking to improve mood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nicotine Dependence, Perceived Behavioral Control, Descriptive Quitting Norms, and Intentions to Quit Smoking among Chinese Male Regular Smokers

The association between nicotine dependence and intentions to quit smoking is well established. However, the underlying mechanisms and psychosocial factors that moderate this relationship have not been adequately delineated. Reinforcement theory, social learning theory, the theory of planned behavior, and the focus theory of normative conduct suggest that perceived behavioral control (PBC) over smoking cessation is a central mechanism that underlies the relationship between nicotine dependence and quitting intentions. Purpose/Objectives: The present study tested a moderated mediation model to examine the roles of PBC over smoking cessation and social norms, in the relationship between nicotine dependence and quit intentions among male regular smokers. Methods: Self-report measures of nicotine dependence, PBC over smoking cessation, descriptive and injunctive quitting norms, and intentions to quit smoking were administered to 204 Chinese male regular smokers. Results: Nicotine dependence was negatively related to quit intentions, and this relationship was mediated by PBC over smoking cessation. Further, the relationship between nicotine dependence and PBC was moderated by descriptive rather than injunctive quitting norms. The negative effects of nicotine dependence on PBC over smoking cessation were not significant among male regular smokers who reported strong descriptive quitting norms. Conclusions/Importance: Poor PBC over smoking cessation underlies the negative effects of nicotine dependence, and descriptive quitting norms act as a buffer against the adverse effects of nicotine dependence on PBC over smoking cessation. These findings have implications for smoking cessation interventions for male regular smokers.

Pain intensity, e-cigarette dependence, and cessation-related outcomes: The moderating role of pain-related anxiety

Pain and nicotine dependence are prevalent, co-occurring conditions posited to interact in the manner of a positive feedback loop; however, most research to date has been conducted among tobacco cigarette smokers. Initial evidence suggests that pain is a risk factor for greater e-cigarette dependence, and additional research is needed to examine covariation between pain and e-cigarette use. There is reason to suspect that pain-related anxiety (i.e., the tendency to respond to pain with anxiety or fear) may be associated with greater e-cigarette dependence and difficulty quitting, and that pain intensity and pain-related anxiety may interact to confer greater risk for e-cigarette use. The current study represents the first examination of cross-sectional associations between pain intensity, pain-related anxiety, and e-cigarette dependence, motivation to quit, history of lifetime e-cigarette quit attempts, perceived barriers to cessation, and negative expectancies during abstinence from e-cigarettes. Participants (N = 520 e-cigarette users, 52.1% female, Mage = 34.85) completed an online survey assessing health behaviors. Results indicated that pain-related anxiety was positively associated with e-cigarette dependence and perceived barriers to cessation (ps < 0.05). Pain-related anxiety was found to moderate relations between pain intensity and primary outcomes, such that pain intensity was positively associated with motivation to quit, likelihood of past failed quit attempt, and negative abstinence expectancies among participants who endorsed high (but not moderate or low) levels of pain-related anxiety. Future research would benefit from examining prospective associations between pain-related anxiety, pain intensity, and e-cigarette use/cessation trajectories among individuals with chronic pain.

Breaking the cycle of smoking and pain: do pain-related anxiety and pain reduction expectancies sabotage attempts to quit smoking and can smoking cessation improve pain and pain-related disability outcomes?

Contemporary models of smoking and pain suggest a reciprocal and self-perpetuating cycle, wherein smoking reduces pain in the short term but indirectly exacerbates pain in the long term. In a sample of participants engaged in an active smoking-cessation attempt, this investigation assessed a) whether specific smoking risk factors (i.e., smoking expectancies for pain reduction, pain-related anxiety) acted as barriers to cessation, and b) whether breaking the smoking-pain cycle through successful smoking abstinence impacted pain and pain-related disability outcomes for participants with pain. Participants comprised 168 smokers (44.4% with pain) who engaged in an online smoking-cessation program. Pain-related anxiety, but not smoking expectancies, accounted for a significant proportion of variance of smoking dependence from pre- to post-intervention. Results suggest that pain-related anxiety is a risk factor for maintained smoking dependence for all smokers regardless of pain status. Participants with pain who successfully quit smoking experienced statistically and clinically meaningful decreases in pain and pain-related disability from pre- to post-intervention. Exploratory post hoc analyses indicated that individuals who signed-up for the smoking cessation program but failed to begin a quit-attempt had significantly higher pain disability, depression, and anxiety scores than participants who commenced a quit-attempt. Theoretical and practical implications are discussed.

Perceived Interrelations of Pain and Cigarette Smoking in a Sample of Adult Smokers Living With HIV/AIDS

INTRODUCTION

Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigarette smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. This study examined the factor structure, reliability, and validity of a measure of perceived interrelations of pain and smoking in a sample of PLWH.

METHODS

Participants in this study were 108 current cigarette smoking PLWH (64.8% reporting current pain) in the Bronx, NY. Participants completed assessments of demographics, smoking behaviors, and pain. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI). The dimensionality of the PSI was evaluated using Horn's Parallel Analysis and exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha, and validity analyses evaluated the relationship between the PSI and demographics, HIV clinical characteristics, smoking, and pain in the total sample.

RESULTS

A single-factor structure was the best fit for the PSI. The internal consistency of the PSI total score was excellent in the total sample (α = 0.94) and among participants with pain (α = 0.93). The PSI total score was significantly higher for PLWH who smoke and had current pain versus no current pain. Among smokers with HIV and pain, higher PSI scores were associated with higher pain interference, pain severity, and certain neuropathic pain symptoms (ie, numbness and pain to touch).

CONCLUSIONS

Among a sample of PLWH, the PSI appeared to be a reliable and valid instrument as a one-factor measure to assess perceived interrelations among pain and cigarette smoking.

IMPLICATIONS

Even though PLWH have very high prevalences of both pain and cigarette smoking, little is known about the relationship between pain and smoking for PLWH. This study is the first to examine a measure of the perceived interrelations of pain and smoking in a sample of PLWH. The measure was reliable and valid, and higher scores, reflecting that higher perceived interrelations of pain and smoking, were associated with more intense pain and pain interference. Learning more about pain and smoking among PLWH will help to better target smoking interventions to this key subgroup of smokers.

Pain-related anxiety and smoking processes: The explanatory role of dysphoria

Scientific evidence suggests that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers with varying levels of pain. Yet, no work has investigated the relation between pain-related anxiety and cognitive-based smoking processes within an indirect effect model. Dysphoria may explain the relation between pain-related anxiety and cigarette smoking, as it is a construct that relates to both pain and smoking outcomes. Thus, the current cross-sectional study examined the indirect effect of pain-related anxiety and three clinically significant smoking processes: perceived barriers to cessation, negative affect reduction motives, and negative mood abstinence expectancies via dysphoria. Participants included 101 (M_age = 32.74 years, SD = 13.60; 35.6% female) adult tobacco cigarette smokers with low cigarette dependence. Results indicated that pain-related anxiety had an indirect effect on all dependent variables through dysphoria. The current findings provide evidence that dysphoria may serve to maintain maladaptive smoking processes in smokers who experience pain-related anxiety. This study furthers research on pain-smoking relations by providing initial evidence for a conceptual model in which smokers with elevated pain-related anxiety endorse greater dysphoric symptoms and use smoking to reduce or escape symptoms of their pain-related anxiety and dysphoria, thus contributing to the maintenance of tobacco dependence.

Associations between Pain-Related Anxiety, Gender, and Prescription Opioid Misuse among Tobacco Smokers Living with HIV/AIDS

BACKGROUND

People living with HIV/AIDS (PLWHA) who smoke cigarettes are vulnerable to greater pain and aberrant use of prescription pain medications. Prescription opioid misuse is highly prevalent among PLWHA and can lead to a variety of adverse outcomes. Pain-related anxiety, which has been implicated in the maintenance of both pain and tobacco dependence, may also play a role in prescription pain medication misuse.

OBJECTIVES

This study aimed to test associations between pain-related anxiety and prescription opioid misuse. We hypothesized that, among those prescribed opioid medication, pain-related anxiety would be positively associated with current opioid misuse, and stated intentions to misuse prescription opioids in the future. We further hypothesized that these relations would be more pronounced among males (vs. females).

METHODS

Participants included 61 PLWHA daily tobacco smokers with pain. Hierarchical regressions were used to test interactions between gender and pain-related anxiety on current and intended opioid misuse among those prescribed opioid medications.

RESULTS

There was a significant interactive effect of pain-related anxiety and gender on opioid misuse, such that pain-related anxiety was positively associated with current opioid misuse among male (but not female) participants who were prescribed opioid medications. Among both males and females, pain-related anxiety was positively associated with intention to misuse prescription pain medications in the future. Conclusions/Importance: Additional research into the role of pain-related anxiety in prescription opioid misuse is warranted. This type of work may inform the development of tailored interventions for PLWHA smokers who are prescribed opioid pain medications.

Clinical Characteristics and Treatment Patterns Among Patients Diagnosed With Cluster Headache in U.S. Healthcare Claims Data

OBJECTIVE

To characterize demographics, clinical characteristics, and treatment patterns of patients with cluster headache (CH).

BACKGROUND

CH is an uncommon trigeminal autonomic cephalalgia with limited evidence-based treatment options. Patients suffer from extremely painful unilateral headache attacks and autonomic symptoms with episodic and chronic cycles.

DESIGN/METHODS

This retrospective analysis used insurance claims from Truven Health Analytics MarketScan® research databases from 2009 to 2014. Two cohorts were compared: CH patients (with ≥2 CH claims) were propensity score matched with 4 non-headache controls, all with continuous enrollment for 12 months before and after the date of first CH claim or matched period among controls.

RESULTS

CH patients (N = 7589) were mainly male (57.4%) and 35-64 years old (73.2%), with significantly more claims for comorbid conditions vs controls (N = 30,341), including depressive disorders (19.8% vs 10.0%), sleep disturbances (19.7% vs 9.1%), anxiety disorders (19.2% vs 8.7%), and tobacco use disorders (12.8% vs 5.3%), with 2.5 times greater odds of suicidal ideation (all P < .0001). Odds of drug dependence were 3-fold greater among CH patients (OR = 2.8 [95% CI 2.3-3.4, P < .0001]). CH patients reported significantly greater use of prescription medications compared with controls; 25% of CH patients had >12 unique prescription drug claims. Most commonly prescribed drug classes for CH patients included: opiate agonists (41%), corticosteroids (34%), 5HT-1 agonists (32%), antidepressants (31%), NSAIDs (29%), anticonvulsants (28%), calcium antagonists (27%), and benzodiazepines (22%). Only 30.4% of CH patients received recognized CH treatments without opioids during the 12-month post-index period. These patients were less likely to visit emergency departments or need hospitalizations (26.8%) as compared to CH patients with no pharmacy claims for recognized CH treatments or opioids (33.6%; P < .0001).

CONCLUSIONS

The burden of CH is associated with significant co-morbidity, including substance use disorders and suicidal ideation, and treatment patterns indicating low use of recognized CH treatments.

Smoking Consequences Questionnaire: A reevaluation of the psychometric properties across two independent samples of smokers

Drug use outcome expectancies are a central construct to psychosocial theories of addictive disorders. In tobacco literature, the Smoking Consequences Questionnaire (SCQ; Brandon & Baker, 1991) is a tool used to assess this construct. Despite its common use, the SCQ has received little psychometric evaluation. In the current report, samples from 2 studies were used to examine the assumed SCQ structure, develop a novel truncated scale, and evaluate the psychometric properties of the novel scale. In Study 1, the 4-factor SCQ structure was examined using data from 343 (32.4% female; M_age = 43.7; SD = 10.8) adult nontreatment-seeking smokers. Results from Study 1 indicated that the 4-factor SCQ structure did not adequately explain covariance between items. Instead, results provided evidence for a 5-factor structure that tapped into outcome expectancies related to (a) immediate negative consequences (IC), (b) long-term negative consequences (LTC), (c) sensory satisfaction (SS), (d) negative affect reduction, and (e) appetite-weight control (AW). In Study 2, the 5-factor structure of the SCQ was confirmed and the construct validity was evaluated in 582 (48.2% female; M_age = 36.9; SD = 13.5) treatment-seeking adult smokers. Study 2 found evidence for measurement invariance across sex and overtime of the 5-factor structure as well as substantial construct validity. Results from 2 independent samples challenge the traditional 4-factor model of the SCQ, and instead, provide evidence for a novel 5-factor SCQ structure with strong validity and reliability. Alternate scoring algorithms for the SCQ, including a 5-subscale scheme, warrant consideration to ensure optimal measurement precision and construct differentiation. (PsycINFO Database Record

Pain-related anxiety as a predictor of early lapse and relapse to cigarette smoking

Although emerging research suggests that pain-related anxiety may play a role in the maintenance of tobacco dependence, no previous work has examined pain-related anxiety as a predictor of smoking cessation outcomes. The current study aimed to test the hypothesis that pain-related anxiety would predict early lapse and relapse to cigarette smoking. These data were collected in the context of a primary study examining the role of emotional vulnerabilities in smoking cessation. The current analyses were conducted among 55 daily cigarette smokers who attempted to quit without psychosocial or pharmacological cessation aids. Pain-related anxiety was assessed at baseline using the Pain Anxiety Symptom Scale-20 (PASS-20). Early lapse and relapse were assessed using timeline follow-back procedures. Cox regression analyses indicated that pain-related anxiety was a significant predictor of both early smoking lapse and relapse such that for every 1-point increase on the PASS-20, the risk of early lapse increased by 3.7% and the risk of early relapse increased by 3.6%. These effects were evident above and beyond the variance accounted for by tobacco dependence, past 4-week pain severity, anxiety sensitivity, and the presence of current Axis I psychopathology. Kaplan-Meier survival analyses further revealed that among early lapsers, greater pain-related anxiety predicted a more rapid trajectory to lapse. Pain-related anxiety was also a significant predictor of early lapse when the sample was limited to smokers with past 4-week pain. These findings lend empirical support to the notion that pain-related anxiety may contribute to the maintenance of tobacco dependence among smokers who experience varying levels of pain intensity. (PsycINFO Database Record

The Perception of Female Smokers with Fibromyalgia on the Effects of Smoking on Fibromyalgia Symptoms

OBJECTIVE

Smokers with fibromyalgia have greater pain intensity and function impairment compared to nonsmokers. Patients' perceptions of interactions between smoking and fibromyalgia symptoms have not been described. The primary aim of this study was to report the perceptions of female smokers with fibromyalgia on how smoking affects symptoms.

METHODS

Forty-eight daily smokers with fibromyalgia enrolled in the Mayo Clinic Fibromyalgia Treatment Center completed the Fibromyalgia Impact Questionnaire, Fagerstrom Test for Nicotine Dependence, Patient Health Questionnaire-9, General Anxiety Disorder-7 and a Fibromyalgia Symptoms and Smoking Survey which queried how smoking directly affected fibromyalgia symptoms (eg, pain, tiredness/fatigue, stiffness, nervousness/anxiety, depression/blueness, irritability, concentration, and overall) or indirectly as a coping mechanism.

RESULTS

The majority of subjects reported smoking had no direct effect on fibromyalgia physical symptoms (pain [60% reported no effect], fatigue [56%], stiffness [81%]) but direct improvement of emotional symptoms (anxiety [62% reported improvement], irritability [64%]). The majority of subjects used smoking to cope with pain (69%) via distraction (83%) and relaxation (77%), lessening emotional distress by reducing a sense of frustration (83%) or sadness (54%) because of pain, and as a justification for resting vis-à-vis "smoke breaks" (69%). Thirty-one smokers were mildly and 17 moderately/severely dependent on tobacco, and no difference in fibromyalgia impact score (P = 0.70), pain (P = 0.39), depression (P = 0.20), and anxiety (P = 0.64) scores were detected, but more moderately/severely dependent subjects reported smoking improved pain (50% vs. 17%, P = 0.04).

DISCUSSION

Smokers with fibromyalgia reported smoking helped to cope with fibromyalgia pain but generally did not directly ameliorate fibromyalgia physical symptoms.

Anxiety and Depression in Bidirectional Relations Between Pain and Smoking: Implications for Smoking Cessation

Pain and tobacco smoking are highly prevalent and comorbid conditions that impose considerable burdens on individuals and health care systems. A recently proposed reciprocal model suggests that these conditions interact in a bidirectional manner, resulting in greater pain and the maintenance of tobacco addiction. Anxiety and depression are common among smokers in pain and have been identified as central mechanisms of interest. There is emerging evidence that smokers with anxiety/depression may experience more severe pain and functional impairment, greater pain-induced motivation to smoke, and increased sensitivity to pain during periods of smoking abstinence. Based on empirical findings, we hypothesize that these experiences may engender expectations that abstaining from smoking will exacerbate both pain and negative affect, thus eroding self-efficacy for smoking cessation and increasing perceived barriers to quitting. The goal of this narrative review is to examine the role of anxiety/depression in complex pain-smoking relations so as to advance evolving theoretical perspectives and inform the development of tailored interventions.

Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain

Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability.

Relations between pain-related anxiety, tobacco dependence, and barriers to quitting among a community-based sample of daily smokers

There is increasing recognition that complex and potentially bidirectional relations between pain and smoking may be relevant to the maintenance of tobacco addiction. Pain-related anxiety has been identified as a mechanism in the onset and progression of painful disorders, and initial evidence indicates that pain-related anxiety may be associated with essential features of tobacco dependence among smokers with chronic pain. However, there has not been an empirical study of pain-related anxiety in relation to tobacco dependence and self-reported barriers to quitting among a community-based sample of daily smokers. The current sample was comprised of 122 daily smokers who were recruited from the local community to participate in a larger study that included an initial assessment of pain, smoking history, and pain-related anxiety. Approximately 17% of our sample endorsed moderate or severe past-month pain, nearly half met criteria for current anxiety or mood disorder, and about 30% met criteria for a current substance use disorder, exclusive of tobacco dependence. Results indicated that pain-related anxiety was uniquely and positively associated with both tobacco dependence severity scores and self-reported barriers to quitting. These findings lend support to the notion that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers who experience varying levels of pain severity.

Understanding the relationship between smoking and pain

This review provides an overview of evidence regarding several key mechanisms pertinent to understanding the co-occurrence of smoking dependence and pain, both potentially costly conditions, and highlights treatment implications and future research directions. We describe each of pain and smoking dependence and introduce a revised integrative reciprocal model that explains their co-occurrence. We then provide a selective review of evidence pertinent to direct and indirect pathways between variables postulated in the model. We also provide general recommendations for improving assessment and treatment of smokers with clinically significant pain. We conclude with a targeted agenda for future investigation of the co-occurrence of smoking and pain. Empirical efforts directed at testing postulates of the proposed integrative model may yield a better understanding of the nature of the relationship between these prevalent and costly health conditions as well as evidence-based preventive and treatment strategies for people who experience nicotine dependence and pain-related disability.

A pilot study of pain-related anxiety and smoking-dependence motives among persons with chronic pain

Complex interactions between pain and tobacco smoking have been of increasing interest to researchers and clinicians from a variety of disciplines. There is also recent evidence to suggest that pain-related anxiety may play an important role in the maintenance of tobacco dependence among persons with comorbid pain disorders. The goal of the current study was to evaluate the explanatory relevance of pain-related anxiety in relation to tobacco dependence among a sample of daily smokers with current chronic pain. Participants were recruited from the general population to complete an online survey that was developed to examine interrelations between chronic pain and tobacco smoking. Fifty-six of 129 (43%) daily smoking respondents met criteria for current chronic pain. Results indicated that pain-related anxiety accounted for a significant portion of the unique variance in total smoking dependence scores, and both primary and secondary dependence composite scores (as measured by the Wisconsin Inventory of Smoking Dependence Motives; Piper et al., 2004). It is noteworthy that these effects were observed above and beyond the variance accounted for by relevant sociodemographic factors, generalized anxiety, and pain severity. Pain-related anxiety was observed to be strongly associated with secondary dependence motives, which is consistent with a conceptualization of pain-related anxiety as an instrumental or situational motivator of smoking. These results suggest that tobacco smokers with comorbid pain disorders may be at risk for maintaining or exacerbating their dependence on tobacco, possibly due to individual differences in pain-related anxiety. These findings may help inform the development of tailored interventions for smokers with comorbid chronic pain.

Current smoking as a predictor of chronic musculoskeletal pain in young adult twins

Chronic pain is common during adolescence and young adulthood and is associated with poor quality of life, depression, and functional disability. Recognizing that chronic pain has significant consequences, it is important to identify modifiable health behaviors that may place young adults at risk for chronic pain. This study examines associations between chronic musculoskeletal pain and smoking in young adult twins (n = 1,588, ages 18-30) participating in a statewide twin registry. Twins completed questionnaires assessing smoking, mood (anxiety, depressive symptoms, and stress), and chronic musculoskeletal pain. Analyses examined associations between chronic pain and smoking, particularly the role of genetics/shared familial factors and psychological symptoms. As predicted, results revealed a near-2-fold increased risk for chronic musculoskeletal pain in twins who currently smoked compared to nonsmokers, even when accounting for psychological factors. Results of within-pair analyses were only minimally attenuated, suggesting that associations between smoking and chronic musculoskeletal pain are better accounted for by nonshared factors than by shared familial factors/genetic effects. Future twin research is needed to identify what nonshared factors (eg, attitudes, direct effects of smoking on pain) contribute to these associations to further understand comorbidity. Longitudinal studies and recruitment of participants prior to smoking initiation and chronic pain onset will better identify causal associations.

PERSPECTIVE

This article describes associations between musculoskeletal pain and smoking in young adult twins, taking into account psychological symptoms. Findings highlight the importance of nonshared factors in associations between pain and smoking and the need to explore the roles of lifestyle, individual attitudes, and direct effects of smoking on pain.

Pain, nicotine, and smoking: research findings and mechanistic considerations

Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Smoking cigarettes as a coping strategy for chronic pain is associated with greater pain intensity and poorer pain-related function

Smoking cigarettes is prevalent among individuals with chronic pain. Some studies indicate nicotine reduces pain and others suggest it may cause or exacerbate pain. Participants in this cross-sectional study were 151 chronic pain patients from a large, urban VA medical center. Patients were divided into 3 groups: 1) nonsmokers; 2) smokers who deny using cigarettes to cope with pain; and 3) smokers who report using cigarettes to cope with pain. Patients who reported smoking as a coping strategy for chronic pain scored significantly worse compared with the other 2 groups on the majority of measures of pain-related outcome. Nonsmokers and smokers who denied smoking to cope did not differ on any variable examined. After controlling for the effects of demographic and clinical factors, smoking cigarettes as a coping strategy for pain was significantly and positively associated with pain intensity (P = .04), pain interference (P = .005), and fear of pain (P = .04). In addition to assessing general smoking status, a more specific assessment of the chronic pain patient's reasons for smoking may be an important consideration as part of interdisciplinary pain treatment.

PERSPECTIVE

This paper describes the relationship between smoking cigarettes as a mechanism to cope with chronic pain and pain-related outcome. Understanding this relationship may illuminate the broader relationship between smoking and chronic pain and provide new directions for effective interdisciplinary pain treatment.

Smoking cessation and chronic pain: patient and pain medicine physician attitudes

Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment-related stressors. Several pain-related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.