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Quirk SE, Koivumaa-Honkanen H, Kavanagh BE, Honkanen RJ, Heikkinen J, Williams LJ. Exploring the comorbidity between personality and musculoskeletal disorders among adults: A scoping review. Front Psychiatry 2022; 13:1079106. [PMID: 36819943 PMCID: PMC9932280 DOI: 10.3389/fpsyt.2022.1079106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is growing awareness of the comorbidity between mental and musculoskeletal disorders (MSDs) and their associated burden. We aimed to explore what is known regarding the existing epidemiological clinical-and population- based literature on the comorbidity between personality disorders (PDs) and MSDs specifically. In addition, we aimed to investigate their associated burden by examining a range of outcomes including morbidity/mortality, patient- and clinical-reported outcomes, work-related outcomes, hospital admissions, and financial costs. Finally, we sought to identify gaps in the literature and provide recommendations for further research. METHODS Studies with participants 15 years of age were eligible. Categorical PDs/features (DSM-III/IV/5 or ICD 9/10), identified by a health care professional, medical records, diagnostic interviews, or self-administered questionnaires. The definitions/groupings of MSDs were guided by the ICD-10 including conditions of the back, joints, and soft tissue, and disorders of bone density and structure. Published peer-reviewed and gray literature were considered. Eligible study designs were cohort, case-control, and cross-sectional studies, and existing reviews of observational studies. Identification and selection of articles, data extraction and the presentation of the results was conducted according to the Joanna Briggs Institute methodological guidance and the PRISMA extension for scoping reviews. RESULTS In total, 57 articles were eligible including 10 reviews and 47 individual studies. Across clinical and population settings, we detected evidence of comorbidity between PDs and chronic back/neck/spine conditions, arthritis, and fibromyalgia, and emerging evidence of associations between PDs and reduced bone mineral density. In terms of knowledge gaps, the burden associated with PDs and MSDs is poorly understood, as is their underlying mechanisms. DISCUSSION This scoping review might prompt further research into PDs and MSDs as separate groups of disorders, along with their comorbidity and the mechanisms that may link them. SYSTEMATIC REVIEW REGISTRATION https://osf.io/mxbr2/registrations.
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Affiliation(s)
- Shae E Quirk
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Bianca E Kavanagh
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Risto J Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.,Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Lana J Williams
- School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia.,Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
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Kong GS, Lee SH, Park KS, Cho JH, Kim KW, Ha IH. Association of temporomandibular disorders and tinnitus with health-related quality of life: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey. J Oral Rehabil 2021; 49:283-294. [PMID: 34862977 DOI: 10.1111/joor.13287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health-related quality of life on a national level. OBJECTIVE We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older. METHODS Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health-related quality of life were assessed using self-report data from EuroQol-5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present. RESULTS Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014-2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570-2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034-2.767), EQ-5D score (OR = 1.651, 95% CI: 1.121-2.431) and EQ-VAS (OR = 1.682, 95% CI: 1.246-2.269). CONCLUSION The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions.
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Affiliation(s)
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | | | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
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Bagdas D, Sevdar G, Gul Z, Younis R, Cavun S, Tae HS, Ortells MO, Arias HR, Gurun MS. (E)-3-furan-2-yl-N-phenylacrylamide (PAM-4) decreases nociception and emotional manifestations of neuropathic pain in mice by α7 nicotinic acetylcholine receptor potentiation. Neurol Res 2021; 43:1056-1068. [PMID: 34281483 DOI: 10.1080/01616412.2021.1949684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Clinical intervention of pain is often accompanied by changes in affective behaviors, so both assays of affective and sensorial aspects of nociception play an important role in the development of novel analgesics. Although positive allosteric modulation (PAM) of α7 nicotinic acetylcholine receptors (nAChRs) has been recognized as a novel approach for the relief of sensorial aspects of pain, their effects on affective components of pain remain unclear. Therefore, we investigated whether PAM-4, a highly selective α7-nAChR PAM, attenuates inflammatory and neuropathic pain, as well as the concomitant depressive/anxiety comorbidities. The anti-nociceptive activity of PAM-4 was assessed in mice using the formalin test and chronic constriction injury (CCI)-induced neuropathic pain model. The anxiolytic- and antidepressant-like activity of PAM-4 was evaluated using the marble burying test and forced swimming test. Acute systemic administration of PAM-4 dose-dependently reversed formalin-induced paw licking behavior and CCI-induced mechanical allodynia without development of any motor impairment. PAM-4 reversed the decreased swimming time and number of buried marbles in CCI-treated mice, suggesting that this ligand attenuates chronic pain-induced depression-like behavior and anxiogenic-like effects. The effects of PAM-4 were inhibited by the α7-selective antagonist methyllycaconitine, indicating molecular mechanism mediated by α7-nAChRs. Indeed, electrophysiological recordings showed the PAM-4 enhances human α7 nAChRs with higher potency and efficacy compared to rat α7 nAChRs. These findings suggest that PAM-4 reduces both sensorial and affective behaviors induced by chronic pain in mice by α7-nAChR potentiation. PAM-4 deserves further investigations for the management of chronic painful conditions with comorbidities.
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Affiliation(s)
- Deniz Bagdas
- Department of Psychiatry, School of Medicine, Yale University, New Haven, USA
| | - Gulce Sevdar
- Department of Pharmacology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Zulfiye Gul
- Department of Pharmacology, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Rabha Younis
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Sinan Cavun
- Department of Pharmacology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Han-Shen Tae
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Wollongong, Australia
| | - Marcelo O Ortells
- Facultad de Medicina, Universidad de Morón, Morón, and CONICET, Moron, Argentina
| | - Hugo R Arias
- Department of Pharmacology and Physiology, Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA
| | - Mine Sibel Gurun
- Department of Pharmacology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Holmes EJ, Aryal S, Walters ST. What lifestyle factors predict depressive symptoms? A longitudinal assessment among permanent supportive housing residents. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Alamir AH, Quadri MFA. Tobacco Use and Orofacial Pain: A Meta-analysis. Nicotine Tob Res 2020; 22:1957-1963. [DOI: 10.1093/ntr/ntaa074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/30/2020] [Indexed: 12/25/2022]
Abstract
Abstract
Introduction
The relationship between smoking and general body ache has been shown to be bidirectional. The specific association between tobacco consumption and orofacial pain remains unclear, however.
Aim and Methods
The aim of this systematic review was to explore the association between pain related to diseases of the oral cavity and use of tobacco. A systematic search of PubMed, Embase, Web of Science, and Cochrane databases was carried out in September 2019. Tobacco exposure was included irrespective of the method of consumption (smokeless and smoked tobacco), and frequency of the habit. The outcome was defined as clinically diagnosed or self-reported pain in the orofacial region, with no limitation in the duration of the condition or the site of the pain.
Results
Altogether, eight studies were selected, with three of them demonstrating good methodology and none of them being of poor quality. Meta-analysis of six studies showed that orofacial pain was significantly worse in tobacco (smoked and smokeless) users (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.92, 6.58) in comparison to nonusers. Subgroup analysis showed that the odds of orofacial pain was three times (OR = 3.13, 95% CI: 1.16, 8.46) higher among smokers, but was not associated with smokeless tobacco.
Conclusions
The odds of experiencing orofacial pain among patients with oral diseases increase for patients who are also smokers. The findings could help dentists and other health specialists more effectively manage patients with orofacial pain who are tobacco consumers.
Implications
This study shows that the odds of orofacial pain among patients with oral diseases increase for patients who are smokers. The results are a significant contribution to the literature because, while the relationship between smoking and general body ache has been shown to be bidirectional, the specific association between tobacco use and orofacial pain warranted further study. The findings could help dentists and other specialists more effectively manage patients with orofacial pain who are also tobacco consumers.
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Affiliation(s)
- Abdulwahab H Alamir
- American Board of Orofacial Pain (ABOP), Department of Diagnostic Sciences and Maxillofacial Surgery, College of Dentistry, Jazan University, Jizan, Saudi Arabia
| | - Mir Faeq Ali Quadri
- Evidence-Based Dentistry, Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jizan, Saudi Arabia
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Saragiotto BT, Kamper SJ, Hodder R, Silva PV, Wolfenden L, Lee H, Oliveira VC, Robson E, Wiggers J, Williams CM. Interventions Targeting Smoking Cessation for Patients With Chronic Pain: An Evidence Synthesis. Nicotine Tob Res 2020; 22:135-140. [PMID: 30481320 DOI: 10.1093/ntr/nty255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/20/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Smoking is a risk factor for chronic pain conditions. Epidemiological evidence suggests that smoking cessation may be an important treatment target in people with chronic pain. The aim of this study was to examine the effectiveness of smoking cessation interventions in people with chronic pain. METHODS We systematically searched for clinical trials investigating the effectiveness of smoking cessation interventions for people with chronic pain, compared with any control comparator. Primary outcomes were pain and physical function. Secondary outcomes were smoking status, quality of life, psychological and cognitive function, and adverse events. We assessed risk of bias using the Cochrane Risk of Bias criteria and the quality of evidence with GRADE. RESULTS Searches retrieved 3845 records and identified two trials for inclusion (total n = 99 participants). There was low-quality evidence of no effect of smoking cessation programs on pain and very low-quality evidence of no effect on function at short-term follow-up. There was conflicting evidence on the effect of smoking cessation interventions for changing the smoking status and number of cigarettes consumed per day. There was no effect on depression and anxiety. CONCLUSION Current evidence does not indicate clinically important effects of smoking cessation interventions in people with chronic pain. There is a need for high-quality trials in this area. IMPLICATIONS Our review highlights an important evidence gap. We found only two studies investigating smoking cessation programs for chronic pain conditions providing very low- to low-quality evidence.
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Affiliation(s)
- Bruno T Saragiotto
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Masters and Doctoral Program in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil.,Centre for Pain, Health and Lifestyle, New South Wales, Australia
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of, Sydney, Sydney, Australia
| | - Rebecca Hodder
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Centre for Pain, Health and Lifestyle, New South Wales, Australia
| | - Priscilla V Silva
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Hopin Lee
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Centre for Statistics in Medicine, Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Vinicius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Emma Robson
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - John Wiggers
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Centre for Pain, Health and Lifestyle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
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Substance-related disorders: A review of prevalence and correlates among patients with chronic pain. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:245-254. [PMID: 28669582 DOI: 10.1016/j.pnpbp.2017.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/25/2023]
Abstract
Over the past few decades, research has revealed high rates of substance-related disorders among patients with chronic pain. In addition to their potentially deleterious health consequences, substance-related disorders have consistently been associated with negative pain-related outcomes among patients with chronic pain. The goal of this narrative review was to provide an overview of studies that have examined the prevalence and correlates of substance-related disorders among patients with chronic pain. A particular focus was placed on opioids, sedatives/hypnotics, cannabis, tobacco, and alcohol given that these substances have received the bulk of research attention among patients with pain. Research conducted to date suggests that a host of biological and psychological factors are likely to contribute to the elevated rates of substance-related disorders among patients with chronic pain. In this review, in addition to reviewing the prevalence and correlates of substance-related disorders among patients with pain, we briefly discussed the changes that were recently made from the DSM-4 to the DSM-5 in the diagnostic criteria for substance-related disorders, and the implications of these changes for the assessment of patients with chronic pain. We also provided a brief overview of instruments that can be used for the assessment of these disorders in clinical and research settings.
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Dixon-Gordon KL, Berghoff CR, McDermott MJ. Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression. J Pers Disord 2018; 32:277-288. [PMID: 28604278 DOI: 10.1521/pedi_2017_31_300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Christopher R Berghoff
- Department of Psychiatry and Human Behavior, University of Mississippi, Medical Center, Jackson, Mississippi
| | - Michael J McDermott
- Department of Psychology, University of Louisiana, Lafayette, Lafayette, Louisiana
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Katyayan PA, Katyayan MK. Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment in Indian patients with temporomandibular disorders: A longitudinal cohort study. J Indian Prosthodont Soc 2017; 17:156-166. [PMID: 28584417 PMCID: PMC5450888 DOI: 10.4103/jips.jips_277_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/30/2017] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Evidence regarding the association of smoking with various forms of chronic musculoskeletal pain is vast, but that with temporomandibular disorders (TMD) is scarce. AIMS The aims of this study are to evaluate the effect of smoking status (SS) and nicotine dependence (ND) on TMD pain intensity and treatment outcome in an Indian population with TMD. SUBJECTS AND METHODS Nine hundred and sixty-two patients with TMD were selected for this longitudinal cohort study. Lifetime SS was evaluated and patients were classified as current smokers (YS), former smokers (FS), or nonsmokers (NS). The Fagerstrom test was used to evaluate the ND of YS. Pain intensity was evaluated using visual analog scale scores. Six months posttreatment, the pain intensity was again recorded. The effect of treatment was evaluated using a global transition outcome measure and categorized as treatment success or failure. A minimum 30% reduction in pain was used as a criterion for categorizing patients as those who had gotten "better." Data obtained from the study were compared using Chi-square tests, paired samples t-tests, and one-way ANOVA tests. The criterion for statistical significance for all analyses was set at P = 0.05. RESULTS Among groups of SS, YS showed the maximum pain intensity at baseline and posttreatment. The outcome of treatment was most successful in NS and least in FS. The number of patients who had gotten "better" after treatment was significantly highest in NS. There was no significant difference between groups of ND with respect to pain intensity, treatment outcome, or "better" patients. CONCLUSIONS Among Indian patients with TMD, smokers reported significantly greater pain intensity and poorer response to treatment than NS. Pain intensity or treatment outcome was independent of ND.
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Affiliation(s)
| | - Manish Khan Katyayan
- Department of Dentistry, GMERS Medical College, Civil Hospital, Gandhinagar, Gujarat, India
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10
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Bastian LA, Fish LJ, Gierisch JM, Stechuchak KM, Grambow SC, Keefe FJ. Impact of Smoking Cessation on Subsequent Pain Intensity Among Chronically Ill Veterans Enrolled in a Smoking Cessation Trial. J Pain Symptom Manage 2015. [PMID: 26210348 DOI: 10.1016/j.jpainsymman.2015.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
CONTEXT Prior cross-sectional studies have reported greater pain intensity among persistent smokers compared with nonsmokers or former smokers; yet, few prospective studies have examined how smoking abstinence affects pain intensity. OBJECTIVES To determine the impact of smoking cessation on subsequent pain intensity in smokers with chronic illness enrolled in a smoking cessation trial. METHODS We recruited veteran smokers with chronic illness (heart disease, cancer, chronic obstructive pulmonary disease, diabetes, or hypertension) for a randomized controlled smoking cessation trial and prospectively examined pain intensity and smoking status. Participants (n = 380) were asked to rate their pain in the past week from 0 to 10 at baseline and the five-month follow-up. The primary outcome measure was self-reported pain intensity at the five-month follow-up survey. Self-reported smoking status was categorized as an abstainer if patients reported no cigarettes in the seven days before the follow-up survey. RESULTS In unadjusted analyses, abstainers reported significantly lower pain levels at the five-month follow-up compared with patients who continued to smoke (parameter estimate = -1.07; 95% CI = -1.77, -0.36). In multivariable modeling, abstaining from cigarettes was not associated with subsequent pain intensity at five-month follow-up (parameter estimate = -0.27; 95% CI = -0.79, 0.25). CONCLUSION Participants who were classified as abstainers did not report significantly different levels of pain intensity than patients who continued to smoke. Future studies should expand on our findings and monitor pain intensity in smoking cessation trials. TRIAL REGISTRATION ClinicalTrials.govNCT00448344.
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Affiliation(s)
- Lori A Bastian
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA; Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA; Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Karen M Stechuchak
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Steven C Grambow
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis J Keefe
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Weingarten TN, Vincent A, Luedtke CA, Beebe TJ, Welch TL, Chong EY, Schroeder DR, Warner DO. The Perception of Female Smokers with Fibromyalgia on the Effects of Smoking on Fibromyalgia Symptoms. Pain Pract 2015; 16:1054-1063. [PMID: 26603674 DOI: 10.1111/papr.12402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Toby N Weingarten
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Ann Vincent
- Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Connie A Luedtke
- Pain Rehabilitation Center, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Timothy J Beebe
- Health Services Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tasha L Welch
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Elisa Y Chong
- Mayo Medical School, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - David O Warner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
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12
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Dixon-Gordon KL, Whalen DJ, Layden BK, Chapman AL. A Systematic Review of Personality Disorders and Health Outcomes. ACTA ACUST UNITED AC 2015; 56:168-190. [PMID: 26456998 DOI: 10.1037/cap0000024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, Amherst MA 01003; Tel: 413-545-0226;
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis MO 63110; Tel: 314-286-2730;
| | - Brianne K Layden
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
| | - Alexander L Chapman
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
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13
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Zale EL, Maisto SA, Ditre JW. Anxiety and Depression in Bidirectional Relations Between Pain and Smoking: Implications for Smoking Cessation. Behav Modif 2015; 40:7-28. [PMID: 26467214 DOI: 10.1177/0145445515610744] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
| | - Stephen A Maisto
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
| | - Joseph W Ditre
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
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14
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Volkman JE, DeRycke EC, Driscoll MA, Becker WC, Brandt CA, Mattocks KM, Haskell SG, Bathulapalli H, Goulet JL, Bastian LA. Smoking Status and Pain Intensity Among OEF/OIF/OND Veterans. PAIN MEDICINE 2015; 16:1690-6. [PMID: 25917639 DOI: 10.1111/pme.12753] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/27/2015] [Accepted: 03/04/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Pain and smoking are highly prevalent among Veterans. Studies in non-Veteran populations have reported higher pain intensity among current smokers compared with nonsmokers and former smokers. We examined the association of smoking status with reported pain intensity among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). DESIGN The sample consisted of OEF/OIF/OND Veterans who had at least one visit to Veterans Affairs (2001-2012) with information in the electronic medical record for concurrent smoking status and pain intensity. The primary outcome measure was current pain intensity, categorized as none to mild (0-3); moderate (4-6); or severe (≥7); based on a self-reported 11-point pain numerical rating scale. Multivariable logistic regression analyses were used to assess the association of current smoking status with moderate to severe (≥4) pain intensity, controlling for potential confounders. RESULTS Overall, 50,988 women and 355,966 men Veterans were examined. The sample mean age was 30 years; 66.3% reported none to mild pain; 19.8% moderate pain; and 13.9% severe pain; 37% were current smokers and 16% former smokers. Results indicated that current smoking [odds ratio (OR) = 1.29 (95% confidence intervals (CI) = 1.27-1.31)] and former smoking [OR = 1.02 (95% CI = 1.01-1.05)] were associated with moderate to severe pain intensity, controlling for age, service-connected disability, gender, obesity, substance abuse, mood disorders, and Post Traumatic Stress Disorder. CONCLUSIONS We found an association between current smoking and pain intensity. This effect was attenuated in former smokers. Our study highlights the importance of understanding reported pain intensity in OEF/OIF/OND Veterans who continue to smoke.
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Affiliation(s)
| | - Eric C DeRycke
- VA Connecticut Healthcare System, West Haven, Connecticut
| | | | - William C Becker
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | | | - Joseph L Goulet
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut.,University of Connecticut Health Center, Farmington, Connecticut
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15
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Zale EL, Maisto SA, Ditre JW. Interrelations between pain and alcohol: An integrative review. Clin Psychol Rev 2015; 37:57-71. [PMID: 25766100 PMCID: PMC4385458 DOI: 10.1016/j.cpr.2015.02.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
Abstract
Pain and alcohol use are both highly prevalent in the general population, and pain-alcohol interrelations are of increasing empirical interest. Previous research has identified associations between pain and alcohol dependence, and the current review provides novel contributions to this emerging domain by incorporating studies that have tested relations between pain and low-to-moderate alcohol consumption, and by identifying potential psychosocial mechanisms of action. Specifically, we sought to integrate evidence of pain-alcohol relations derived from two directions of empirical inquiry (i.e., effects of alcohol on pain and effects of pain on alcohol use) across psychological, social, and biological literatures. We observed converging evidence that associations between alcohol consumption and pain may be curvilinear in nature. Whereas moderate alcohol use was observed to be associated with positive pain-related outcomes (e.g., greater quality of life), excessive drinking and alcohol use disorder appear to be associated with deleterious pain-related outcomes (e.g., greater pain severity). We also observed evidence that alcohol administration confers acute pain-inhibitory effects, and that situational pain may motivate alcohol consumption (e.g., drinking for pain-coping). Future research can inform theoretical and clinical applications through examination of temporal relations between pain and alcohol consumption, tests of hypothesized mechanisms, and the development of novel interventions.
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Affiliation(s)
- Emily L Zale
- Syracuse University, Syracuse, NY 13244, United States
| | - Stephen A Maisto
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States
| | - Joseph W Ditre
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States.
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16
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Luger TM, Suls J, Vander Weg MW. How robust is the association between smoking and depression in adults? A meta-analysis using linear mixed-effects models. Addict Behav 2014; 39:1418-29. [PMID: 24935795 DOI: 10.1016/j.addbeh.2014.05.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 04/29/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Our objective was to use meta-analytic techniques to assess the strength of the overall relationship and role of potential moderators in the association between smoking and depression in adults. METHODS Two popular health and social science databases (PubMed and PsycINFO) were systematically searched to identify studies which examined the association between adult smoking behavior and major depressive disorder (MDD) or depressive symptoms. A total of 85 relevant studies were selected for inclusion. Studies were analyzed using a linear mixed effects modeling package ("lme4" for R) and the Comprehensive Meta-Analysis program version 2. RESULTS Multiple nested linear mixed-effects models were compared. The best fitting models were those that included only random study effects and smoking status. In cross-sectional studies, current smokers were more likely to be depressed than never smokers (OR=1.50, CI=1.39-1.60), and current smokers were more likely to be depressed than former smokers (OR=1.76, CI=1.48-2.09). The few available prospective studies, that used the requisite statistical adjustments, also showed smokers at baseline had greater odds of incident depression at follow-up than never smokers (OR=1.62, CI=1.10-2.40). CONCLUSIONS In cross-sectional studies, smoking was associated with a nearly two-fold increased risk of depression relative to both never smokers and former smokers. In the smaller set of prospective studies, the odds of subsequent depression were also higher for current than never smokers. Attesting to its robustness, the relationship between smoking and depression was exhibited across several moderators. Findings could help health care providers to more effectively anticipate co-occurring health issues of their patients. Several methodological recommendations for future research are offered.
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Unrod M, Gironda RJ, Clark ME, White KE, Simmons VN, Sutton SK, Brandon TH. Smoking behavior and motivation to quit among chronic pain patients initiating multidisciplinary pain treatment: a prospective study. PAIN MEDICINE (MALDEN, MASS.) 2014; 15:1294-303. [PMID: 24528473 PMCID: PMC4374596 DOI: 10.1111/pme.12364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The primary aim of this study was to assess smoking characteristics and cessation motivation prior to and after initiation of multidisciplinary chronic pain treatment. A secondary aim was to identify predictors of cessation motivation among smokers initiating treatment for chronic pain. DESIGN We used a prospective, nonrandomized, repeated measures design. SETTING The study was conducted in a multidisciplinary specialty pain treatment program at a veterans hospital. PATIENTS Smokers (N = 90) referred to a multidisciplinary pain program for the treatment of chronic pain. MEASURES Patients completed questionnaires assessing pain-related and smoking-related factors prior to (baseline) and 8 weeks post (follow-up) specialty pain treatment initiation. Primary outcome measures were the Contemplation Ladder and the Stages of Change (SOC) algorithm. RESULTS At baseline, patients reported moderate levels of cessation motivation, and 69% were in the contemplation stage or higher on the SOC. Motivation to quit smoking was higher at follow-up compared with baseline on both continuous, t(89) = 2.11, P < 0.05, and stage-based, z = 3.69, P < 0.01, measures. At follow-up, participants reported greater interest in receiving cessation interventions, and 7.8% of patients had quit smoking. Pain-related predictors of motivation (e.g., pain intensity) were subsumed by more general predictors (e.g., nicotine dependence). CONCLUSIONS Patients in this sample were more motivated to quit smoking a few weeks after, as compared with before initiating specialty pain treatment. Future research into pain-specific predictors of cessation motivation is warranted to inform the development of interventions that address pain patients' unique needs.
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Affiliation(s)
- Marina Unrod
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida
| | | | | | | | - Vani N. Simmons
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida
| | - Steven K. Sutton
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida
| | - Thomas H. Brandon
- H. Lee Moffitt Cancer Center & Research Institute
- University of South Florida
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18
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Burris JL, Perez C, Evans DR, Carlson CR. A preliminary study of cigarette smoking in female orofacial pain patients. Behav Med 2014; 39:73-9. [PMID: 23930899 DOI: 10.1080/08964289.2012.731439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between behavior (eg, diet, exercise, substance use) and the functioning of chronic-pain patients, including orofacial-pain patients, is poorly understood. This preliminary study examined cigarette smoking and both pain-related and psychological functioning in female orofacial-pain patients. Correlates of intentions to quit smoking were also explored. There were 48 participants in this cross-sectional study. Smokers reported significantly less self-control over pain (d = .66), lower general activity levels (d = .52), more fatigue (d = .80), and poorer sleep quality (d = .53) than non-smokers. The mean effect size for all dependent variables was .49 (range, .33-.80) with the smallest and largest effect found for negative mood and fatigue, respectively. More positive attitudes toward smoking cessation independently predicted stronger intentions to quit (β = .52, p = .03). Findings suggest smoking is significantly associated with pain-related and psychological functioning in female orofacial-pain patients. Smoking-cessation treatment for these patients should include motivational interviewing techniques directed toward attitudinal change.
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Affiliation(s)
- Jessica L Burris
- Hollings Cancer Center-Cancer Prevention & Control, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
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Hooten WM, Townsend CO, Hays JT, Ebnet KL, Gauvin TR, Gehin JM, Laures HJ, Patten CA, Warner DO. A cognitive behavioral smoking abstinence intervention for adults with chronic pain: a randomized controlled pilot trial. Addict Behav 2014; 39:593-9. [PMID: 24333035 DOI: 10.1016/j.addbeh.2013.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
Abstract
Current evidence suggests it may be difficult for patients with chronic pain to quit smoking and, based on previous formative work, a 7-session individual and group-based cognitive behavioral (CB) intervention was developed. The primary aim of this randomized controlled pilot trial was to test the hypothesis that abstinence at month 6 would be greater among patients with chronic pain who received the CB intervention compared to a control condition. Upon admission to a 3-week interdisciplinary pain treatment (IPT) program, patients were randomized to receive the CB intervention (n=30) or the control condition (n=30). The 7-day point prevalence of self-reported smoking status was assessed at week 3 (upon completion of the 3-week IPT program) and at month 6 in an intent-to-treat analysis. At week 3, 30% (n=9) of patients in the CB condition were abstinent from smoking compared to 10% (n=3) in the control group (P=.104). At month 6, 20% (n=6) of patients who received the CB intervention were abstinent compared to none in the control group (P=.024). At week 3, a significant group by time interaction effect was found where the CB patients experienced greater improvements in self-efficacy from baseline compared to the control group (P=.002). A greater proportion of patients randomized to the CB group completed the IPT program (P=.052). The findings of this pilot trial suggest that integration of a CB-based smoking abstinence intervention into ongoing pain therapy may be an effective treatment for smokers with chronic pain.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology, Mayo College of Medicine, Rochester, MN, United States.
| | - Cynthia O Townsend
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - J Taylor Hays
- Department of Internal Medicine, Mayo College of Medicine, Rochester, MN, United States
| | - Kaye L Ebnet
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Thomas R Gauvin
- Department of Internal Medicine, Mayo College of Medicine, Rochester, MN, United States
| | - Jessica M Gehin
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Heidi J Laures
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - David O Warner
- Department of Anesthesiology, Mayo College of Medicine, Rochester, MN, United States
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20
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van Hecke O, Torrance N, Cochrane L, Cavanagh J, Donnan PT, Padmanabhan S, Porteous DJ, Hocking L, Smith BH. Does a history of depression actually mediate smoking-related pain? Findings from a cross-sectional general population-based study. Eur J Pain 2014; 18:1223-30. [PMID: 24577799 DOI: 10.1002/j.1532-2149.2014.00470.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Smokers report more pain and worse functioning. The evidence from pain clinics suggests that depression affects this relationship: The association between smoking and chronic pain is weakened when controlling for depression. This study explored the relationship between smoking, pain and depression in a large general population-based cohort (Generation Scotland: Scottish Family Health Study). METHODS Chronic pain measures (intensity, disability), self-reported smoking status and a history of major depressive disorder (MDD) were analysed. A multivariate analysis of covariance determined whether smoking status was associated with both pain measures and a history of depressive illness. Using a statistical mediation model any mediating effect of depression on the relationship between smoking and chronic pain was sought. RESULTS Of all 24,024 participants, 30% (n = 7162) reported any chronic pain. Within this chronic pain group, 16% (n = 1158) had a history of MDD; 7108 had valid smoking data: 20% (n = 1408) were current smokers, 33% (n = 2351) former and 47% (n = 3349) never smokers. Current smokers demonstrated higher pain intensity and pain-related disability scores compared with former and non-smokers (p < 0.001 for all analyses). From the mediation model, the effect on pain intensity decreased (p < 0.001), indicating that the relationship between smoking and a history of depression contributes significantly to the effect of smoking on pain intensity. When applied to smoking-related pain disability, there was no mediation effect. CONCLUSIONS In contrast to smokers treated in pain clinics, a history of MDD mediated the relationship between smoking and pain intensity, but not pain-related disability in smokers in the community.
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Affiliation(s)
- O van Hecke
- Medical Research Institute, University of Dundee, UK
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21
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Stipelman BA, Augustson E, McNeel T. The relationship among smoking, sleep, and chronic rheumatic conditions commonly associated with pain in the National Health Interview Survey. J Behav Med 2013; 36:539-48. [PMID: 22864597 PMCID: PMC3858964 DOI: 10.1007/s10865-012-9447-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 07/20/2012] [Indexed: 12/21/2022]
Abstract
Chronic rheumatic conditions are typically characterized by chronic pain and are uniquely associated with increased rates of cigarette smoking and poor sleep quality. However, no study has examined the possible additive or interactive effects of these two health behaviors in individuals diagnosed with a chronic rheumatic condition. The goal of this study is to examine the relationship between cigarette smoking and sleep in a population sample of individuals diagnosed with a chronic rheumatic condition and related functional impairment. Cross sectional survey data was obtained from the 2007 National Health Interview Survey. Individuals diagnosed with a chronic rheumatic condition were more likely to be a former or current smoker compared to non-diagnosed individuals. Individuals with a chronic rheumatic condition were more likely to report <6 h of sleep per night and endorsed significantly more insomnia and daytime sleepiness. There was no interaction between diagnosis of a chronic rheumatic condition and smoking status on any of the sleep outcomes assessed. Finally, an interaction was observed suggesting individuals with a chronic rheumatic condition who currently smoke are more likely to report averaging <6 h of sleep per night and frequent insomnia compared to individuals with a chronic rheumatic condition who never smoked. These results suggest both a unique and additive relationship between smoking and sleep in individuals with a chronic rheumatic condition. Findings can likely be generalized to other conditions commonly associated with chronic pain.
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Affiliation(s)
- Brooke A Stipelman
- Science of Research and Technology Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20892-7326, USA.
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22
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Smoking as a risk factor for chronic musculoskeletal complaints is influenced by age. The HUNT Study. Pain 2013; 154:1073-9. [DOI: 10.1016/j.pain.2013.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/01/2013] [Accepted: 03/11/2013] [Indexed: 11/17/2022]
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Fishbain DA, Lewis JE, Bruns D, Meyer LJ, Gao J, Disorbio JM. The prevalence of smokers within chronic pain patients and highest pain levels versus comparison groups. PAIN MEDICINE 2012; 14:403-16. [PMID: 23279699 DOI: 10.1111/pme.12024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES.: The objectives of this study were to (1) compare the prevalence of smoking within chronic pain patients (CPPs) to community non-patients without pain (CNPWP), community patients with pain (CPWP), and acute pain patients (APPs); and (2) compare smokers to nonsmokers within CPPs, APPs, and CPWP for highest pain level. DESIGN.: CNPWP, CPWP, APPs, and CPPs were compared to each other for smoking status (nonsmoker, less than one pack per day, one pack/day or more, any amount per day). Within CPWP, APPs, and CPPs, smokers were also compared to nonsmokers by t-test for highest reported pain level. For both analyses, sub-analyses were performed controlling for age or gender, or race or education. RESULTS.: Utilizing all available patients, the prevalence of smokers within CPPs was significantly greater vs each of the comparison groups (CNPWP, CPWP, APPs). In the sub-analyses, only CPPs who were 38 or younger or male or White, or had some college or above were at greater risk than CPWP for smoking one pack or greater per day. CPP smokers were not significantly more likely than nonsmokers to have higher pain, and this was confirmed in the sub-analyses. CONCLUSIONS.: The prevalence of smokers could be significantly greater within CPPs vs CPWP. CPPs who smoke do not have higher levels of pain than nonsmoking CPPs.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at University of Miami, Miami, FL 33136, USA.
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24
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Darnall BD, Stacey BR, Chou R. Medical and psychological risks and consequences of long-term opioid therapy in women. PAIN MEDICINE 2012; 13:1181-211. [PMID: 22905834 DOI: 10.1111/j.1526-4637.2012.01467.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term opioid use has increased substantially over the past decade for U.S. women. Women are more likely than men to have a chronic pain condition, to be treated with opioids, and may receive higher doses. Prescribing trends persist despite limited evidence to support the long-term benefit of this pain treatment approach. PURPOSE To review the medical and psychological risks and consequences of long-term opioid therapy in women. METHOD Scientific literature containing relevant keywords and content were reviewed. RESULTS AND CONCLUSIONS Long-term opioid use exposes women to unique risks, including endocrinopathy, reduced fertility, neonatal risks, as well as greater risk for polypharmacy, cardiac risks, poisoning and unintentional overdose, among other risks. Risks for women appear to vary by age and psychosocial factors may be bidirectionally related to opioid use. Gaps in understanding and priorities for future research are highlighted.
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Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
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25
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de Moraes Vieira EB, Garcia JBS, da Silva AAM, Mualem Araújo RLT, Jansen RCS. Prevalence, characteristics, and factors associated with chronic pain with and without neuropathic characteristics in São Luís, Brazil. J Pain Symptom Manage 2012; 44:239-51. [PMID: 22871508 DOI: 10.1016/j.jpainsymman.2011.08.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/19/2011] [Accepted: 09/01/2011] [Indexed: 12/28/2022]
Abstract
CONTEXT Chronic pain (CP) with and without neuropathic characteristics is a public health problem. This is the first population-based study in South America, and the third in the world, to use the Douleur Neuropathique 4 Questions (DN4) tool in epidemiologic studies. OBJECTIVES The objectives were to estimate the prevalence and associated factors of CP with and without neuropathic characteristics in São Luís, Brazil. METHODS We surveyed 1597 people. The DN4 questionnaire was applied. Poisson regression was used to analyze the risk factors. RESULTS The prevalence of CP was 42%, and 10% had CP with neuropathic characteristics (CPNC). The results showed that female sex and age ≥30 years were associated with an increased prevalence of CP (P<0.001) and education ≥12 years with a reduction in the prevalence of CP. The sensations listed in the DN4 were more common in people with CPNC and most frequent were pins and needles (87.9%). The cephalic region (36%) and limbs (51%) were the locations most affected. Most respondents felt pain between six months and four years (51.6%), with daily frequency (45%). Pain intensity, the impediments caused by pain, and sadness were more prevalent in people who had CPNC (P<0.001). Health status was regular for most, 50.9% did not know the cause of their pain, 64.1% used drugs, and only 7% had consulted with a pain specialist. Dissatisfaction with treatment was reported by 55%. CONCLUSION CP with and without neuropathic characteristics is a public health problem in Brazil, with high prevalence and great influence on people's daily lives.
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Fishbain DA, Cole B, Lewis JE, Gao J. Is smoking associated with alcohol-drug dependence in patients with pain and chronic pain patients? An evidence-based structured review. PAIN MEDICINE 2012; 13:1212-26. [PMID: 22845022 DOI: 10.1111/j.1526-4637.2012.01446.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine if there is consistent evidence for smoking to be considered a red flag for development of opioid dependence during opioid exposure in patients with pain and chronic pain patients (CPPs). METHODS Six hundred and twenty-three references were found that addressed the areas of smoking, pain, and drug-alcohol dependence. Fifteen studies remained after exclusion criteria were applied and sorted into four groupings addressing four hypotheses: patients with pain and CPPs who smoke are more likely than their nonsmoking counterparts to use opioids, require higher opioid doses, be drug-alcohol dependent, and demonstrate aberrant drug-taking behaviors (ADTBs). Each study was characterized by the type of study it represented according to the Agency for Health Care Policy and Research (AHCPR) guidelines and independently rated by two raters according to 13 quality criteria to generate a quality score. The percentage of studies in each grouping supporting/not supporting each hypothesis was calculated. The strength and consistency of the evidence in each grouping was rated by the AHCPR guidelines. RESULTS In each grouping, 100% of the studies supported the hypothesis for that grouping. The strength and consistency of the evidence was rated as A (consistent multiple studies) for the first hypothesis and as B (generally consistent) for the other. CONCLUSIONS There is limited consistent indirect evidence that smoking status in patients with pain and CPPs is associated with alcohol-drug and opioid dependence. Smoking status could be a red flag for opioid-dependence development on opioid exposure.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at the University of Miami, FL, USA.
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27
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Cigarette smoking and pain: depressive symptoms mediate smoking-related pain symptoms. Pain 2012; 153:1749-1754. [PMID: 22703693 DOI: 10.1016/j.pain.2012.05.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/20/2012] [Accepted: 05/11/2012] [Indexed: 11/22/2022]
Abstract
Numerous studies have shown an association between smoking and pain, with smokers reporting more pain and worse functioning. However, little is known about factors that impact this complex relationship. This study investigated the association between smoking, pain, and depressive symptoms. Participants were new patients seen at a multidisciplinary pain clinic. All patients were mailed an intake packet of validated questionnaires as part of an ongoing research and clinical care initiative. Of the 497 patients evaluated, 426 had valid smoking data. Among these patients, 32.6% (n = 139) reported being current smokers, 31.7% (n = 135) were classified as former smokers, and 35.7% (n = 152) were never smokers. A multivariate analysis of covariance (smoking status, age, gender, education) revealed a main effect for pain severity (F = 7.36, P<0.001), pain interference (F = 4.03, P = 0.001), and depressive symptoms (F = 7.87, P<0.001). Current smokers demonstrated higher pain severity, pain interference, and depressive symptoms compared with former smokers and never smokers (P<0.01 for all analyses), while there were no differences between the former-smoker and never-smoker groups. However, the effect of smoking on pain severity (P = 0.06) and pain interference (P = 0.22) was no longer significant after controlling for depressive symptoms in a mediation model. Additionally, among former smokers, longer quit duration was associated with less pain severity. In conclusion, smoking rates were high and smoking was associated with a worse chronic pain phenotype. Importantly, depressive symptoms emerged as a critical mediating factor in helping to explain the relationship between smoking and pain.
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Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull 2012; 137:1065-93. [PMID: 21967450 DOI: 10.1037/a0025544] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
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).
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Texas A&M University, College Station, USA.
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Creech CJ, Clark S, Grube G, Louisell-McFawn M, Rench J, Wiltse K, McFarland M. Nurse practitioner management of chronic musculoskeletal pain: a chart review. Nurse Pract 2011; 36:29-36. [PMID: 21857215 DOI: 10.1097/01.npr.0000403292.15266.0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study explored NPs' management of chronic musculoskeletal pain via a record review of 50 uninsured patients. The findings include a summary of the utilization of services and treatments along with demographic data. Recommendations for education, practice, and further research are discussed.
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Smoking habits influence pain and functional and psychiatric features in fibromyalgia. Joint Bone Spine 2011; 78:259-65. [DOI: 10.1016/j.jbspin.2010.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/20/2010] [Indexed: 11/18/2022]
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Hooten WM, Vickers KS, Shi Y, Ebnet KL, Townsend CO, Patten CA, Warner DO. Smoking cessation and chronic pain: patient and pain medicine physician attitudes. Pain Pract 2011; 11:552-63. [PMID: 21518246 DOI: 10.1111/j.1533-2500.2011.00462.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Sá KN, Pereira CDM, Souza RC, Baptista AF, Lessa I. Knee pain prevalence and associated factors in a Brazilian population study. PAIN MEDICINE 2011; 12:394-402. [PMID: 21332935 DOI: 10.1111/j.1526-4637.2011.01063.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the association among knee pain and central obesity. METHODS A cross-sectional study was carried out in Salvador, Brazil, with a sample of 2,297 individuals ≥20 years of age. A standardized questionnaire was applied at home to collect data about pain, sociodemographic characteristics and abdominal circumference measurement. Unadjusted (bivariate analysis) and adjusted odds ratio (OR) and 95%CI were estimated by using backward stepwise logistic regression. RESULTS The prevalence of knee pain was found in 11.2% of the studied sample. Unadjusted OR associations (P<0.1) were found for male (OR 2.70, CI [confidence interval] 2.01-3.63), older age (OR 2.98, CI 1.89-4.42), and obesity (OR 1.62, CI 1.22-2.15). Adjusted ORs (P<0.05) were found for obesity-married individuals (OR 4.69, CI 1.09-20.11), separated (OR 11.03, CI 2.09-58.20) or widowed (OR 7.17, CI 1.40-36.61), and male (OR 2.35, CI 1.25-4.41). The OR of nonobese men was 2.66, CI 1.74-4.06, but being married seems to protect them of knee pain (OR 0.66, CI 0.45-0.96). CONCLUSION In this study, we found a knee pain prevalence of 11.2% and positive association with the male gender, married, separated or widowed, and a protective association for knee pain in nonobese married male. Aging, obesity, and excessive alcohol consumption were independent correlates of knee pain in the studied population sample.
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Affiliation(s)
- Katia N Sá
- Post-graduation Department, Bahian School of Medicine and Public Health, Federal University of Bahia, Salvador, BA, Brazil.
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Hooten MW, Shi Y, Gazelka HM, Warner DO. The effects of depression and smoking on pain severity and opioid use in patients with chronic pain. Pain 2010; 152:223-229. [PMID: 21126821 DOI: 10.1016/j.pain.2010.10.045] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/11/2010] [Accepted: 10/28/2010] [Indexed: 11/28/2022]
Abstract
Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (n=1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P=.001) and clinical pain (P=.001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P=.005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27mg/d), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids. This study found that pain severity was associated with greater depression but not smoking; however, smoking was associated with greater opioid use, independent of depression.
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Affiliation(s)
- Michael W Hooten
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55902, USA Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN 55902, USA Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA Department of Anesthesiology, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Ditre JW, Heckman BW, Butts EA, Brandon TH. Effects of expectancies and coping on pain-induced motivation to smoke. JOURNAL OF ABNORMAL PSYCHOLOGY 2010; 119:524-33. [PMID: 20677841 DOI: 10.1037/a0019568] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of tobacco smoking among persons with recurrent pain is approximately twice that observed in the general population. Smoking has been associated with the development and exacerbation of several chronically painful conditions. Conversely, there is both experimental and cross-sectional evidence that pain is a potent motivator of smoking. A recent study provided the first evidence that laboratory-induced pain could elicit increased craving and produce shorter latencies to smoke (Ditre & Brandon, 2008). To further elucidate interrelations between pain and smoking, and to identify potential targets for intervention, in the current study, we tested whether several constructs derived from social-cognitive theory influence the causal pathway between pain and increased motivation to smoke. Smokers (N = 132) were randomly assigned to 1 of 4 conditions in this 2 x 2 between-subjects experimental design. Results indicated that manipulations designed to (a) challenge smoking-related outcome expectancies for pain reduction and (b) enhance pain-related coping produced decreased urge ratings and increased latencies to smoke, relative to controls. An unexpected interaction effect revealed that although each manipulation was sufficient to reduce smoking urges, the combination was neither additive nor synergistic. These findings were integrated with those of the extant literature to conceptualize and depict a causal pathway between pain and motivation to smoke as moderated by smoking-related outcome expectancies and mediated by the use of pain coping behaviors.
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Affiliation(s)
- Joseph W Ditre
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 East Fowler Avenue, Tampa, FL 33617, USA
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Chronic musculoskeletal pain and cigarette smoking among a representative sample of Canadian adolescents and adults. Addict Behav 2010; 35:1008-12. [PMID: 20621422 DOI: 10.1016/j.addbeh.2010.06.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/29/2010] [Accepted: 06/14/2010] [Indexed: 11/22/2022]
Abstract
The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechanisms underlying the association between chronic pain and smoking.
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Gonzalez A, Hogan J, McLeish AC, Zvolensky MJ. An evaluation of pain-related anxiety among daily cigarette smokers in terms of negative and positive reinforcement smoking outcome expectancies. Addict Behav 2010; 35:553-7. [PMID: 20153120 PMCID: PMC3184247 DOI: 10.1016/j.addbeh.2010.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/24/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
The present investigation sought to evaluate the unique explanatory relevance of pain-related anxiety in relation to negative and positive reinforcement smoking outcome expectancies among 135 (40.7% female; M(age) = 26.11, SD = 11.23) adult daily cigarette smokers. As predicted, pain-related anxiety was significantly related to greater expectancies that smoking will decrease negative affect, and lesser expectancies that smoking will result in positive outcomes. The observed effects were evident above and beyond the variance accounted for by gender, current level of non-specific bodily pain, daily cigarette use, relations with non-criterion outcome expectancies, and shared variance with anxiety sensitivity. Results suggest that there may be segments of the smoking population who are at relatively greater risk for certain expectancies for tobacco smoking by virtue of individual differences in pain-related anxiety.
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Affiliation(s)
- Adam Gonzalez
- University of Vermont, Burlington, VT 05405-0134, United States
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Broekmans S, Dobbels F, Milisen K, Morlion B, Vanderschueren S. Determinants of medication underuse and medication overuse in patients with chronic non-malignant pain: a multicenter study. Int J Nurs Stud 2010; 47:1408-17. [PMID: 20471648 DOI: 10.1016/j.ijnurstu.2010.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 02/20/2010] [Accepted: 03/20/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND In chronic non-malignant pain, medication is often used as an important cornerstone of the treatment. Medication non-adherence is a frequent problem in chronic conditions. In patients with chronic non-malignant pain, medication non-adherence ranges between 8% and 53%. Two types of non-adherence can be identified: underuse and overuse of pain medication. OBJECTIVE To examine determinants of both medication underuse and overuse non-adherence in patients with chronic non-malignant pain, with a focus on factors related to all five categories of determinants of medication non-adherence simultaneously, as proposed by the WHO. DESIGN A multicenter cross-sectional study. SETTINGS Three multidisciplinary outpatient pain centers in Flanders, Belgium. PARTICIPANTS A total of 265 patients with chronic non-malignant pain participated in the study. METHODS Medication non-adherence was assessed by a self-report interview. Associations of socio-economic, treatment related, condition related, patient related and health care system related factors with medication underuse or overuse were determined by building two separate multivariable binary logistic regression models. RESULTS Thirty eight percent of the patients were fully adherent. Based on multivariable analyses, underuse was significantly associated with more prescribed analgesics (OR=2.303), self-medication (OR=4.679), lower pain intensity (OR=0.821), active coping strategies (OR=1.132) and lack of information (OR=0.268). Overuse of medication was associated with more prescribed analgesics (OR=1.645) and current smoking (OR=2.744). CONCLUSION Patients underusing or overusing their medication do have a different risk profile. The set of determinants of non-adherence, proposed by WHO, is suitable to study determinants of underuse, but the framework is less suitable to study determinants of medication overuse.
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Affiliation(s)
- Susan Broekmans
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Zvolensky MJ, McMillan K, Gonzalez A, Asmundson GJG. Chronic pain and cigarette smoking and nicotine dependence among a representative sample of adults. Nicotine Tob Res 2009; 11:1407-14. [PMID: 19828432 DOI: 10.1093/ntr/ntp153] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Individuals with chronic pain problems are at an increased risk for certain types of substance abuse and dependence. Recent work suggests that there is a significant association between chronic pain and cigarette smoking; however, it is unclear as to whether pain-smoking effects are evident above and beyond sociodemographic factors and cooccurring substance use disorders. The present investigation examined the relation between lifetime and current (past year) chronic pain and cigarette smoking status and nicotine dependence. METHODS This investigation comprised a large representative sample of English-speaking adults (n = 9,282) residing in the United States. Data were collected primarily through face-to-face interviews conducted between February 2001 and April 2003. RESULTS After adjusting for sociodemographic variables and the presence of a lifetime substance use disorder, individuals with a lifetime history of chronic neck or back pain were significantly more likely to be current smokers and to be diagnosed with lifetime as well as current nicotine dependence. Although there was no significant incremental relation between current chronic neck and back pain and being a current smoker, there was a significant association with lifetime and current nicotine dependence. Similar relations were evident among those with and without medically unexplained chronic pain in regard to smoking status and lifetime and current nicotine dependence. DISCUSSION Findings are discussed in terms of better understanding the chronic pain-smoking association.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Vermont, Burlington, VT 05405-0134, USA.
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Sá K, Baptista AF, Matos MA, Lessa I. Prevalence of chronic pain and associated factors in the population of Salvador, Bahia. Rev Saude Publica 2009; 43:622-30. [PMID: 19488666 DOI: 10.1590/s0034-89102009005000032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 12/04/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of chronic pain, identifying the associated factors. METHODS A cross-sectional study was conducted in a population sample of 2,297 individuals aged 20 years or more, in Salvador, Northeastern Brazil, in 1999 and 2000. A standardized questionnaire was administered at the individuals' home to collect data about pain, sociodemographic characteristics, and abdominal circumference measurement. The criterion for chronic pain classification was duration above six months. Prevalence of pain was estimated by adjusted prevalence ratio with confidence interval of 95% and p<0.05 for the univariate analyses and logistic regression. RESULTS The presence of chronic pain was found in 41.4% of the population. In the gross analysis, the most frequent associated factors were: sex, age, marital status, smoking and alcohol consumption (p<0.05). In the multivariate analysis, female sex, age, smoking and presence of central obesity were independent predictors, while moderate consumption of alcohol and being single were protectors. CONCLUSIONS The presence of chronic pain was predominant in women, elderly individuals, obese individuals, smokers and ex-smokers. Preventive public health strategies are suggested, aiming to disseminate the risks of smoking and obesity for the development of chronic pain. In addition, the periodic monitoring of health is encouraged.
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Affiliation(s)
- Katia Sá
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
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Hooten WM, Townsend CO, Bruce BK, Schmidt JE, Kerkvliet JL, Patten CA, Warner DO. Effects of Smoking Status on Immediate Treatment Outcomes of Multidisciplinary Pain Rehabilitation. PAIN MEDICINE 2009; 10:347-55. [DOI: 10.1111/j.1526-4637.2008.00494.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fishbain DA, Lewis JE, Gao J, Cole B, Steele Rosomoff R. Are chronic low back pain patients who smoke at greater risk for suicide ideation? PAIN MEDICINE 2009; 10:340-6. [PMID: 19254332 DOI: 10.1111/j.1526-4637.2009.00570.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is significant psychiatric literature indicating that smoking is associated with all forms of suicidality, including suicide ideation. The goal of this study was to determine if smoking is associated with suicide ideation in chronic low back pain (CLBP) patients. DESIGN CLBP patients identified themselves as either current smokers (N = 81) or nonsmokers (N = 140) and completed a number of evaluation instruments, which included the Beck Depression Inventory (BDI) and the Coping Strategies Questionnaire (CSQ). BDI question number 9 was utilized to define CLBP with suicide ideation and subsequently, in addition, items number 3 and number 6 from the CSQ were added to the BDI item number 9 in order to fully capture CLBP with suicide ideation. Utilizing this expanded definition of suicide ideation (BDI plus CSQ), CLBP smokers were compared with CLBP nonsmokers for the frequency of suicide ideation. Regression analysis was utilized to investigate the CLBP smoking suicide ideation group. Finally, we investigated whether heavy use of alcohol and coffee impacted on CLBP heavy smokers in terms of increasing suicide ideation risk. SETTING CLBP patients were recruited from a pain facility. RESULTS CLBP smokers were more likely to complain of suicide ideation, and this relationship correlated with the number of cigarettes smoked per day. Seventy-eight percent of the CLBP smokers were classified correctly in terms of the presence of suicide ideation by three variables: diagnosis of major depression, Function Assessment Questionnaire total score, and BDI total score. The relative risk of suicide ideation was increased by combining heavy smoking (greater than one pack per day) with heavy alcohol use. CONCLUSIONS CLBP smokers appear to be at greater risk for suicide ideation than nonsmoking CLBP patients. The risk of suicide ideation is even greater if the CLBP patient is a heavy smoker and has problems with alcohol.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
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Fishbain DA, Lewis JE, Cutler R, Cole B, Steele Rosomoff R, Rosomoff HL. Does smoking status affect multidisciplinary pain facility treatment outcome? PAIN MEDICINE 2009; 9:1081-90. [PMID: 19067831 DOI: 10.1111/j.1526-4637.2007.00306.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Smoking may be a major problem in chronic low back pain (LBP) patients. The goal of this study was to determine whether smoking status affected multidisciplinary pain facility treatment outcome. DESIGN As part of a grant study, chronic LBP patients identified themselves as either current smokers (N = 81) or current nonsmokers (N = 140), and were compared by chi-square for employment status at 1, 6, 12, and 24 months after multidisciplinary pain facility treatment. Smokers who were unemployed at each time interval were then compared with employed smokers for a large number of assessment scales and clinical variables of interest by chi-square or Student's t-test. The significant independent variables from these analyses were then utilized in a logistic regression to determine predictors for smoker nonemployment. SETTING Pain facility. RESULTS Current smokers were less likely to be employed at each follow-up time point. Pain levels over the previous 24 hours predicted employment status for current smokers at 1-, 12-, and 24-month follow-up, while worker compensation status predicted employment status at 6 months. CONCLUSIONS Current smoking status appears to be associated with poorer treatment outcome after multidisciplinary pain facility treatment. Return to work within smokers is predicted by pain and worker compensation status. Pain facilities should target current smokers with significant perceived pain for close treatment monitoring in an attempt to improve treatment outcome.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at University of Miami, Florida 33136, USA.
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Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH. Impact of Tobacco Use in Patients Presenting to a Multidisciplinary Outpatient Treatment Program for Fibromyalgia. Clin J Pain 2009; 25:39-43. [DOI: 10.1097/ajp.0b013e31817d105e] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hooten WM, Townsend CO, Bruce BK, Warner DO. The Effects of Smoking Status on Opioid Tapering Among Patients with Chronic Pain. Anesth Analg 2009; 108:308-15. [DOI: 10.1213/ane.0b013e31818c7b99] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jakobsson U. Tobacco Use in Relation to Chronic Pain: Results from a Swedish Population Survey. PAIN MEDICINE 2008; 9:1091-7. [DOI: 10.1111/j.1526-4637.2008.00473.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sá KN, Baptista AF, Matos MA, Lessa Í. Chronic pain and gender in Salvador population, Brazil. Pain 2008; 139:498-506. [PMID: 18672325 DOI: 10.1016/j.pain.2008.06.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 04/27/2008] [Accepted: 06/02/2008] [Indexed: 11/24/2022]
Abstract
Chronic pain is a public health problem with high impact on various population segments. There are few population studies with the aim of delineating the profile of the chronic pain patient, and generating data for actions to prevent, control and minimize the problem. The aim of this study was to estimate the prevalence of chronic pain in the population of Salvador, Bahia, Brazil and identify independent predictors associated with this morbidity. A cross-sectional study was conducted in a sample population of 2297 individuals of >20 years of age, in Salvador, Brazil. A standardized questionnaire was applied at home to collect data about socio-demographic characteristics, lifestyle, chronic pain and abdominal circumference measurement. The chronic pain was defined as pain with a duration of longer than 6 months. Prevalence of pain and the OR (univariate analysis) were estimated and adjusted (logistic regression), and their ICs at 95% and p<0.05 in the two analyses. The presence of chronic pain was found in 41.4% of the total study population, women being more affected (48.4% against 32.8% in men), with OR of 1.92 IC 95% 1.6-2,28 p<0.001. Among the studied factors, in the gross analysis, the following were shown to be associated with chronic pain: conjugal situation, smoking, excessive alcohol consumption, presence of central obesity and age, all with p<0.05. In the multivariate analysis, female sex, smoking, excessive alcohol consumption, and age were sustained as independent predictors. The presence of chronic pain was predominant in women, the elderly, smokers or ex-smokers and excessive alcohol consumers.
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Affiliation(s)
- Katia Nunes Sá
- Escola Bahiana de Medicina e Saúde Pública, Fundação Bahiana para Desenvolvimento das Ciências, Programa de Pos-graduacao e extensao da, Rua D.Joao VI, 274 - Brotas, 40290-000 Salvador, Bahia, Brazil Instituto de Saúde Coletiva, Universidade Federal da Bahia, Brazil
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Gallagher RM, Rosenthal LJ. Chronic Pain and Opiates: Balancing Pain Control and Risks in Long-Term Opioid Treatment. Arch Phys Med Rehabil 2008; 89:S77-82. [DOI: 10.1016/j.apmr.2007.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 12/06/2007] [Indexed: 11/16/2022]
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