Understanding the relationship between smoking and pain

Abstract

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

Keywords::

• acute pain
• anxiety
• chronic pain
• dependence
• depression
• fear-avoidance
• smoking
• negative affect
• review

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • There is a high co-occurrence of smoking and pain, and the relationship between smoking and pain appears to be both causal and reciprocal.

• • The reciprocal relationship appears to be reinforced through a variety of mechanisms including the following:

  • – Smoking has been implicated as an indirect causal factor in the development of acute and chronic musculoskeletal pain, as well as an acute analgesic that provides temporary relief from pain.

  • – Pain can increase levels of negative affect for which smoking provides temporary relief.

  • – Multidirectional risk interactions exist between anxiety/depressive psychopathology and smoking and chronic pain.

• • Future research is needed to conduct causal-oriented testing of the role of smoking in the onset and maintenance of pain problems, as well as the role of smoking in chronic pain relapse.

• • Laboratory studies are necessary to understand the role of specific aspects of smoking behavior in pain problems.

• • Systematic dissemination and training in terms of smoking–pain relations may be necessary for improved outcomes for pain problems among smokers as well as smoking cessation outcomes among those with chronic pain.

• • Efforts to further refine models explaining shared vulnerability and mutual (reciprocal) maintenance will stimulate further empirical efforts and refinement of evidence-based preventive and treatment strategies for people who experience nicotine dependence and pain-related disability.

Notes