Chronic Pain Status, Nicotine Withdrawal, and Expectancies for Smoking Cessation Among Lighter Smokers

Ditre, Joseph W.; Kosiba, Jesse D.; Zale, Emily L.; Zvolensky, Michael J.; Maisto, Stephen A.

doi:10.1007/s12160-016-9769-9

Cited by 54 publications

(47 citation statements)

References 51 publications

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“…Indeed, tobacco smoking has been identified as a unique risk factor in the development of chronic pain [72; 75], pain has been shown to motivate smoking behavior [20; 21], current smoking has been linked to more severe pain and functional impairment among treatment-seeking pain patients [33], and there is mounting evidence that pain may impede smoking cessation [24; 25; 83]. Although it has been suggested that chronic exposure to nicotine and tobacco smoke may increase sensitivity to pain over time [22, 70], these results indicate that nicotine can also produce short-term analgesic effects.…”

Section: Discussionmentioning

confidence: 99%

Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis

Ditre

Heckman

Zale

et al. 2016

Pain

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119

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Although animal models have consistently demonstrated acute pain-inhibitory effects of nicotine and tobacco, human experimental studies have yielded mixed results. The main goal of this meta-analysis was to quantify the effects of nicotine/tobacco administration on human experimental pain threshold and tolerance ratings. A search of PubMed and PsychINFO online databases identified 13 eligible articles, including k = 21 tests of pain tolerance (N = 393) and k = 15 tests of pain threshold (N = 339). Meta-analytic integration for both threshold and tolerance outcomes revealed that nicotine administered via tobacco smoke and other delivery systems (e.g., patch, nasal spray) produced acute analgesic effects that may be characterized as small to medium in magnitude (Hedges’ g = .35, 95% CI = .21-.50). Publication bias-corrected estimates remained significant and indicated that these effects may be closer to small. Gender composition was observed to be a significant moderator, such that pain threshold effects were more robust among samples that included more men than women. These results help to clarify a mixed literature, and may ultimately help to inform the treatment of both pain and nicotine dependence. Pain and tobacco smoking are both highly prevalent and comorbid conditions, current smoking has been associated with more severe chronic pain and physical impairment, and acute nicotine-induced analgesia could make smoking more rewarding and harder to give up. Future research should employ dynamic measures of experimental pain reactivity and further explore biopsychosocial mechanisms of action.

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Section: Discussionmentioning

confidence: 99%

Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis

Ditre

Heckman

Zale

et al. 2016

Pain

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119

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“…Finally, consistent with evidence that pain can motivate smoking, there are some data to suggest that pain may impede smoking cessation. For example, smokers in pain (relative to no pain) tend to endorse greater difficulty when attempting to quit and less confidence in their ability to remain abstinent during future quit attempts (Ditre, Kosiba, Zale, Zvolensky, & Maisto, under review; Zale et al, 2014). In addition, both acute pain reactivity (Nakajima & al’Absi, 2011) and positive chronic pain status (Waldie, McGee, Reeder, & Poulton, 2008) have been linked with smoking relapse trajectories.…”

Section: Bidirectional Relations Between Pain and Tobacco Smokingmentioning

confidence: 99%

“…Indeed, smokers with chronic pain who endorse greater withdrawal severity during past quit attempts have been shown to anticipate more severe withdrawal/negative affect during future quit attempts (Ditre, Kosiba, et al, under review). Consistent with evidence that past cessation failures may erode confidence for future success (Carey & Carey, 1993; Kirchner, Shiffman, & Wileyto, 2012), smokers in pain have also been shown to report lower levels of self-efficacy and greater perceived barriers to quitting, in part due to having experienced more severe withdrawal and greater difficulty during previous quit attempts (Ditre, Kosiba, et al, under review; Zale et al, 2014). Thus, smokers with comorbid anxiety, depression, and pain may be more likely to encounter difficulty maintaining abstinence, which may engender expectations that ultimately serve to undermine future quit attempts.…”

Section: Implications For Smoking Cessationmentioning

confidence: 99%

“…An integrated CBT-based cessation protocol for smokers with comorbid pain and anxiety/depression could incorporate functional analysis to aid in the identification of pain- and affect/mood-relevant proximal antecedents and consequences of smoking, psychoeducation to prepare these smokers for more severe withdrawal and increased sensitivity to pain during the early stages of a quit attempt, and cognitive restructuring that addresses the perceived utility of smoking for pain coping and affect regulation. Smokers in pain may also benefit from pre-cessation interventions that seek to enhance self-efficacy for quitting by teaching alternative and more adaptive (i.e., non-smoking-related) strategies for coping with both pain and anxiety/depression (e.g., Ditre, Kosiba, et al, under review; Zale et al, 2014). …”

Section: Tailored Approaches To Tobacco Dependence Treatmentmentioning

confidence: 99%

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Anxiety and Depression in Bidirectional Relations Between Pain and Smoking

2015

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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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“…Rates of tobacco smoking among individuals in pain (28%–68%; Goesling, Brummett, & Hassett, 2012; Michna et al, 2004; Orhurhu, Pittelkow, & Hooten, 2015; Patterson et al, 2012) far exceed those observed in the general population (18%; CDC, 2014), and smokers with chronic pain (vs. no chronic pain) are nearly two times more likely to meet diagnostic criteria for nicotine dependence (Zvolensky, McMillan, Gonzalez, & Asmundson, 2009). Smokers who live with pain have also been shown to consume more cigarettes per day and report less confidence in their ability to quit than pain-free smokers (Ditre, Kosiba, Zale, Zvolensky, & Maisto, 2016; Zale, Ditre, Dorfman, Heckman, & Brandon, 2014). Despite emerging evidence that tobacco smokers with comorbid pain may constitute a recalcitrant subgroup that faces unique barriers to smoking cessation (Ditre, Langdon, Kosiba, Zale, & Zvolensky, 2015; Zale & Ditre, 2013), the extent to which individuals perceive their pain and smoking behavior to be interrelated remains understudied.…”

Section: Introductionmentioning

confidence: 99%

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

Ditre

Zale

Heckman

et al. 2016

Cognitive Behaviour Therapy

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Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e., pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The 9-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.

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Chronic Pain Status, Nicotine Withdrawal, and Expectancies for Smoking Cessation Among Lighter Smokers

Abstract: Background-Chronic pain and tobacco smoking are both highly prevalent and comorbid conditions, and chronic pain may pose a barrier to smoking cessation.

Cited by 54 publications

References 51 publications

Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis

Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis

Anxiety and Depression in Bidirectional Relations Between Pain and Smoking

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

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