Relations between pain-related anxiety, tobacco dependence, and barriers to quitting among a community-based sample of daily smokers

Abstract

There is increasing recognition that complex and potentially bidirectional relations between pain and smoking may be relevant to the maintenance of tobacco addiction. Pain-related anxiety has been identified as a mechanism in the onset and progression of painful disorders, and initial evidence indicates that pain-related anxiety may be associated with essential features of tobacco dependence among smokers with chronic pain. However, there has not been an empirical study of pain-related anxiety in relation to tobacco dependence and self-reported barriers to quitting among a community-based sample of daily smokers. The current sample was comprised of 122 daily smokers who were recruited from the local community to participate in a larger study that included an initial assessment of pain, smoking history, and pain-related anxiety. Approximately 17% of our sample endorsed moderate or severe past-month pain, nearly half met criteria for current anxiety or mood disorder, and about 30% met criteria for a current substance use disorder, exclusive of tobacco dependence. Results indicated that pain-related anxiety was uniquely and positively associated with both tobacco dependence severity scores and self-reported barriers to quitting. These findings lend support to the notion that pain-related anxiety may contribute to the maintenance of tobacco addiction among smokers who experience varying levels of pain severity.

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

“…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.…”

Pain-related fear, disability, and the fear-avoidance model of chronic pain

“…There is also some evidence of covariation between pain-related anxiety and severity of tobacco dependence among persons with and without chronic pain [43,44], there is converging evidence that tobacco smoking may serve an escape/avoidance function in response to pain [45], and smokers have been shown to report greater levels of pain-related disability than nonsmokers [42,46]. Taken together, these data suggest that pain-related anxiety may motivate smoking, and that ongoing tobacco use may be associated with poorer disability outcomes.…”

Anxiety and Depression in Bidirectional Relations Between Pain and Smoking

“…Specifically, among smokers with chronic pain, greater levels of pain-related anxiety have been associated with smoking dependence motives (Ditre, Zale, Kosiba, & Zvolensky, 2013) and expectancies for negative affect reduction via tobacco smoking (Gonzalez, Hogan, McLeish, & Zvolensky, 2010). Smokers who report greater pain-related anxiety have also been shown to endorse greater levels of tobacco dependence and to perceive more barriers to smoking cessation (Ditre et al, 2015). Moreover, researchers have suggested that pain-related anxiety may contribute to the effects of pain on smoking by serving as a situational motivator of smoking, and that smokers who endorse greater levels of pain-related anxiety may favor the use of nicotine/tobacco over other more adaptive strategies for pain coping (Ditre et al, 2015; Ditre et al, 2013).…”

“…Smokers who report greater pain-related anxiety have also been shown to endorse greater levels of tobacco dependence and to perceive more barriers to smoking cessation (Ditre et al, 2015). Moreover, researchers have suggested that pain-related anxiety may contribute to the effects of pain on smoking by serving as a situational motivator of smoking, and that smokers who endorse greater levels of pain-related anxiety may favor the use of nicotine/tobacco over other more adaptive strategies for pain coping (Ditre et al, 2015; Ditre et al, 2013). …”