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Robinson CL, Kim RS, Li M, Ruan QZ, Surapaneni S, Jones M, Pak DJ, Southerland W. The Impact of Smoking on the Development and Severity of Chronic Pain. Curr Pain Headache Rep 2022; 26:575-581. [PMID: 35731364 DOI: 10.1007/s11916-022-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the impact of smoking and its role on the development of chronic pain and provide a critical review of recent literature. RECENT FINDINGS Recent studies demonstrate the bidirectional and dependent relationship between smoking and chronic pain. Those who are in pain have a more difficult time in the cessation of smoking as well as an increased sensitivity to pain during abstinence, lower confidence, and higher relapse rates. The fear of pain and the anxiety and depression that abstinence causes results in a grim outcome for long-term cessation. The dependent nature between chronic pain and smoking is affected by numerous variables. Providers should consider a multiprong approach to treating chronic pain and targeting smoking cessation treatment by providing motivational therapy, nicotine replacement, and medication therapies to prevent relapse, and providing those who are more likely to relapse with a higher level of care.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Rosa S Kim
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Michael Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Sindhuja Surapaneni
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Mark Jones
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Daniel J Pak
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Warren Southerland
- Department of Anesthesia, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Bastian LA, Driscoll M, DeRycke E, Edmond S, Mattocks K, Goulet J, Kerns RD, Lawless M, Quon C, Selander K, Snow J, Casares J, Lee M, Brandt C, Ditre J, Becker W. Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain. Contemp Clin Trials Commun 2021; 23:100839. [PMID: 34485755 PMCID: PMC8391053 DOI: 10.1016/j.conctc.2021.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results The 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.
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Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Eric DeRycke
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Sara Edmond
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Kristin Mattocks
- University of Massachusetts Medical School, Worcester, MA, United States.,VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Joe Goulet
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mark Lawless
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Caroline Quon
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Kim Selander
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer Snow
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jose Casares
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Megan Lee
- Yale University School of Medicine, New Haven, CT, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - William Becker
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
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Hammett PJ, Businelle MS, Taylor BC, Erbes CR, Bastian L, Doran N, Sherman SE, Rogers ES, Burgess DJ, Fu SS. The Association Between Smoking Abstinence and Pain Trajectory Among Veterans Engaged in U.S. Department of Veterans Affairs Mental Health Care. PAIN MEDICINE 2021; 22:1793-1803. [PMID: 33502511 DOI: 10.1093/pm/pnab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time. DESIGN A secondary analysis of the "Proactive Outreach for Smokers in VA Mental Health" study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care. METHODS Participants were categorized into "low" (n = 616), "moderate" (n = 479), and "severe" pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups. RESULTS There were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores. CONCLUSIONS In this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael S Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Christopher R Erbes
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota Medical School, Minnesota
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut.,School of Medicine, Yale University, New Haven, Connecticut
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Erin S Rogers
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain 2020; 160:2374-2379. [PMID: 31149975 DOI: 10.1097/j.pain.0000000000001631] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tobacco smoking is associated with adverse health effects, and its relationship to pain is complex. The longitudinal effect of smoking on patients attending a tertiary pain management center is not well established. Using the Collaborative Health Outcomes Information Registry of patients attending the Stanford Pain Management Center from 2013 to 2017, we conducted a propensity-weighted analysis to determine independent effects of smoking on patients with chronic pain. We adjusted for covariates including age, sex, body mass index, depression and anxiety history, ethnicity, alcohol use, marital status, disability, and education. We compared smokers and nonsmokers on pain intensity, physical function, sleep, and psychological and mood variables using self-reported NIH PROMIS outcomes. We also conducted a linear mixed-model analysis to determine effect of smoking over time. A total of 12,368 patients completed the CHOIR questionnaire of which 8584 patients had complete data for propensity analysis. Smokers at time of pain consultation reported significantly worse pain intensities, pain interference, pain behaviors, physical functioning, fatigue, sleep-related impairment, sleep disturbance, anger, emotional support, depression, and anxiety symptoms than nonsmokers (all P < 0.001). In mixed-model analysis, smokers tended to have worse pain interference, fatigue, sleep-related impairment, anger, emotional support, and depression over time compared with nonsmokers. Patients with chronic pain who smoke have worse pain, functional, sleep, and psychological and mood outcomes compared with nonsmokers. Smoking also has prognostic importance for poor recovery and improvement over time. Further research is needed on tailored therapies to assist people with chronic pain who smoke and to determine an optimal strategy to facilitate smoking cessation.
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Affiliation(s)
- Lisa R. LaRowe
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
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Bastian LA, Heapy A, Becker WC, Sandbrink F, Atkins D, Kerns RD. Understanding Pain and Pain Treatment for Veterans: Responding to the Federal Pain Research Strategy. PAIN MEDICINE 2018; 19:S1-S4. [PMID: 30203012 DOI: 10.1093/pm/pny143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center (West Haven COIN), VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alicia Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center (West Haven COIN), VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - William C Becker
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center (West Haven COIN), VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Friedhelm Sandbrink
- National Program for Pain Management, Specialty Care Services, VHA, Washington DC
| | - David Atkins
- VA Health Services Research and Development Service, Office of Research and Development, Washington DC
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center (West Haven COIN), VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Departments of Neurology, Yale University, New Haven, Connecticut, USA; ‖
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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