Characteristics of Urban Inpatient Smokers With and Without Chronic Pain: Foundations for Targeted Cessation Programs

Abstract

Background: Cigarette smoking and chronic pain are prevalent, comorbid conditions with significant consequences for individuals and society. Despite overlap between smoking and chronic pain, and pain’s role as a potential barrier to quitting, there are no validated interventions targeted for smokers with chronic pains (SWCPs). Objective: To compare characteristics of urban inpatient smokers with and without chronic pain to inform the development of SWCP-targeted cessation interventions. Methods: This study reports partial results from a randomized comparative effectiveness trial of two smoking cessation interventions (NCT01363245). Participants were enrolled at two safety net hospitals in New York, NY in 2011–2014. Data were collected from the electronic health record and an interviewer-administered survey. Participants were considered to have chronic pain if they affirmed having “long-lasting, persistent, or chronic pain in the last six months” on survey. Results: Among smokers assessed for pain (n = 1093), the prevalence of chronic pain was 44%. SWCPs were more likely to report depressive symptoms and to have a history of psychiatric diagnosis (nonsubstance related) than smokers without pain. Severe problems with mobility and with performing usual activities were more common in SWCPs. No significant difference was observed in sex, race, education, nicotine dependence level, confidence in quit ability, or history of substance misuse. Conclusions/Importance: Chronic pain in smokers admitted to safety net hospitals is prevalent and associated with hindered mobility, history of psychiatric diagnosis, and prescription opioid use. Urban safety net hospitals are an appropriate setting in which to pilot SWCP-targeted cessation programs, which should be designed with consideration for patients’ psychiatric history and mobility status.

Keywords:

• Smoking cessation; chronic pain; tobacco use disorder; cigarette smoking; inpatients

Acknowledgements

The data analysis performed here was not preregistered with an independent, institutional registry. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of NIH or the Department of Veterans Affairs or the US Government.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by a grant (1U01HL105229) and Hurricane Sandy Supplement (3U01HL105229-04S1) from the National Heart, Lung and Blood Institute at the National Institutes of Health, and also in part by a New York University CTSA grant (UL1TR000038) from the National Center for Advancing Translational Sciences at the National Institutes of Health. One of the authors (SES) is also supported by a grant from the National Institute on Drug Abuse (1K24DA038345) and by the VA New York Harbor Healthcare System.