Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients

Overview

Journal Pain Med

Specialties Critical Care
Neurology
Psychiatry

Date 2015 Mar 25

PMID 25801019

Citations 24

Authors

Jenna Goesling

Chad M Brummett

Taha S Meraj

Stephanie E Moser

Afton L Hassett

Joseph W Ditre

Affiliations

Soon will be listed here.

Abstract

Objective: As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes.

Methods: Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia.

Results: Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference.

Conclusions: Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge.

Citing Articles

Female Sex, Fibromyalgia Diagnosis, Obesity, Tobacco Use, Preoperative Opioid Use, and Postoperative Recurrent Instability Are Risk Factors for Return to the Emergency Department 1 Year After Arthroscopic Shoulder Stabilization.

Brady J, Lapite I, Yim A, Yoo J Arthrosc Sports Med Rehabil. 2025; 7(1):101016.

PMID: 40041815 PMC: 11873478. DOI: 10.1016/j.asmr.2024.101016.

Differences in anxiety, depression and pain experience among adults with chronic low back pain as a function of nicotine product use.

Zvolensky M, Smit T, Rogers A, Bakhshaie J, Ditre J, Rinker D J Behav Med. 2025; .

PMID: 39789403 DOI: 10.1007/s10865-024-00547-6.

Mitochondrial miRNAs and fibromyalgia: new biomarker candidates.

Rasulova K, Dilek B, Kavak D, Pehlivan M, Kizildag S Mol Biol Rep. 2024; 52(1):16.

PMID: 39589649 DOI: 10.1007/s11033-024-10110-w.

Attentional Bias for Opioids in Taiwanese Heavy Smokers with Chronic Noncancer Pain.

Liu L, Lin E, Tsao S, Wang H, Ho M Medicina (Kaunas). 2024; 60(7).

PMID: 39064536 PMC: 11279384. DOI: 10.3390/medicina60071107.

Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective.

Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E J Clin Med. 2024; 13(3).

PMID: 38337338 PMC: 10855981. DOI: 10.3390/jcm13030644.

References

Hooten M, Shi Y, Gazelka H, Warner D . The effects of depression and smoking on pain severity and opioid use in patients with chronic pain. Pain. 2010; 152(1):223-229. PMC: 3026611. DOI: 10.1016/j.pain.2010.10.045. View

Ditre J, Brandon T . Pain as a motivator of smoking: effects of pain induction on smoking urge and behavior. J Abnorm Psychol. 2008; 117(2):467-72. PMC: 4391507. DOI: 10.1037/0021-843X.117.2.467. View

Hahn E, Rayens M, Kirsh K, Passik S . Brief report: pain and readiness to quit smoking cigarettes. Nicotine Tob Res. 2006; 8(3):473-80. DOI: 10.1080/14622200600670355. View

Wolfe F, Clauw D, Fitzcharles M, Goldenberg D, Hauser W, Katz R . Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011; 38(6):1113-22. DOI: 10.3899/jrheum.100594. View

Ditre J, Brandon T, Zale E, Meagher M . Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull. 2011; 137(6):1065-93. PMC: 3202023. DOI: 10.1037/a0025544. View

Parkerson H, Zvolensky M, Asmundson G . Understanding the relationship between smoking and pain. Expert Rev Neurother. 2013; 13(12):1407-14. DOI: 10.1586/14737175.2013.859524. View

Hooten W, Townsend C, Hays J, Ebnet K, Gauvin T, Gehin J . A cognitive behavioral smoking abstinence intervention for adults with chronic pain: a randomized controlled pilot trial. Addict Behav. 2013; 39(3):593-9. PMC: 4412145. DOI: 10.1016/j.addbeh.2013.11.010. View

Trivedi M, Rush A, Wisniewski S, Nierenberg A, Warden D, Ritz L . Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006; 163(1):28-40. DOI: 10.1176/appi.ajp.163.1.28. View

Breslau N . Psychiatric comorbidity of smoking and nicotine dependence. Behav Genet. 1995; 25(2):95-101. DOI: 10.1007/BF02196920. View

10.

Butler A, Chapman J, Forman E, Beck A . The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2005; 26(1):17-31. DOI: 10.1016/j.cpr.2005.07.003. View

11.

Scott D, Domino E, Heitzeg M, Koeppe R, Ni L, Guthrie S . Smoking modulation of mu-opioid and dopamine D2 receptor-mediated neurotransmission in humans. Neuropsychopharmacology. 2006; 32(2):450-7. DOI: 10.1038/sj.npp.1301238. View

12.

Vogt M, Hanscom B, Lauerman W, Kang J . Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine (Phila Pa 1976). 2002; 27(3):313-9. DOI: 10.1097/00007632-200202010-00022. View

13.

Morriss R, Wearden A . Screening instruments for psychiatric morbidity in chronic fatigue syndrome. J R Soc Med. 1998; 91(7):365-8. PMC: 1296809. DOI: 10.1177/014107689809100706. View

14.

Clauw D, Witter J . Pain and rheumatology: thinking outside the joint. Arthritis Rheum. 2009; 60(2):321-4. DOI: 10.1002/art.24326. View

15.

Pamuk O, Donmez S, Cakir N . The frequency of smoking in fibromyalgia patients and its association with symptoms. Rheumatol Int. 2009; 29(11):1311-4. DOI: 10.1007/s00296-009-0851-5. View

16.

Dersh J, Polatin P, Gatchel R . Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002; 64(5):773-86. DOI: 10.1097/01.psy.0000024232.11538.54. View

17.

Waldie K, McGee R, Reeder A, Poulton R . Associations between frequent headaches, persistent smoking, and attempts to quit. Headache. 2008; 48(4):545-52. DOI: 10.1111/j.1526-4610.2007.01037.x. View

18.

Breslau N, Fenn N, Peterson E . Early smoking initiation and nicotine dependence in a cohort of young adults. Drug Alcohol Depend. 1993; 33(2):129-37. DOI: 10.1016/0376-8716(93)90054-t. View

19.

Hooten W, Vickers K, Shi Y, Ebnet K, Townsend C, Patten C . Smoking cessation and chronic pain: patient and pain medicine physician attitudes. Pain Pract. 2011; 11(6):552-63. PMC: 4439580. DOI: 10.1111/j.1533-2500.2011.00462.x. View

20.

Yunus M, Arslan S, Aldag J . Relationship between fibromyalgia features and smoking. Scand J Rheumatol. 2002; 31(5):301-5. DOI: 10.1080/030097402760375214. View