• Lara K Dhingra, Peter Homel, Bella Grossman, Jack Chen, Elyssa Scharaga, Steven Calamita, Jae Shin, and Russell Portenoy.
• *Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York Departments of †Neurology and Psychiatry and Behavioral Sciences §Medicine #Neurology and Anesthesiology, Albert Einstein College of Medicine ¶Albert Einstein College of Medicine of Yeshiva University, Bronx ‡Maimonides Medical Center, Brooklyn ∥The New School for Social Research, New York, NY.
• Clin J Pain. 2014 Mar 1; 30 (3): 205-13.

ObjectivesSmoking is associated with chronic pain and pain-related functional impairment. Some studies suggest that pain activates smoking urges and others suggest that smoking is analgesic. We evaluated these associations using ecological momentary assessment, a method for real-time measurement of health-related phenomena.MethodsFor 1 week, 36 chronic pain patients who smoked a mean of 17.5 (SD=9.4) cigarettes per day completed multiple daily assessments on a handheld computer.ResultsThe sample included 67% women and 39% whites; 67% had back pain, with an average (SD) worst pain severity during the past week of 8.6 (1.5) on a 0 to 10 numeric rating scale. Patients completed an average (SD) of 44 (24) random assessments. At each assessment, the patient recorded pain "right now" on a 0 to 10 scale, whether he/she was "about to smoke," and if he/she had "just smoked in the past 30 minutes," pain before smoking. After controlling for other significant correlates of pain, patients who were about to smoke had more pain than at other times (M [SD]=6.5 [2.3] vs. 5.2 [2.4]; P<0.01), but pain before and after smoking was not different (M [SD]=6.1 [2.2] vs. 5.9 [2.3]; P=0.18).DiscussionThese findings support the hypothesis that smoking behavior is triggered by pain, but smoking is not analgesic. Future studies should clarify potential explanatory mechanisms for this pain-related trigger and evaluate tailored cessation strategies for pain patients.

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