Abstract

Tobacco smoking is associated with adverse health effects and its relationship to pain is complex. The longitudinal effect of smoking on patients attending a tertiary pain management center is not wellestablished. Using the Collaborative Health Outcomes Information Registry (CHOIR) of patients attending the Stanford Pain Management Center from 2013-2017, we conducted a propensity-weighted analysis to determine independent effects of smoking on chronic pain patients. We adjusted for covariates including age, gender, body mass index, depression and anxiety history, ethnicity, alcohol use, marital status, disability, and education. We compared smokers and non-smokers on pain intensity, physical function, sleep, and psychological and mood variables using self-reported NIH PROMIS outcomes. We also conducted a linear mixed-model analysis to determine effect of smoking over time. 12,368 patients completed the CHOIR questionnaire of which 8,584 patients had complete data for propensity analysis. Smokers at time of pain consultation reported significantly worse pain intensities, pain interference, pain behaviors, physical functioning, fatigue, sleep-related impairment, sleep disturbance, anger, emotional support, depression, and anxiety symptoms than non-smokers (all p<0.001). In mixed model analysis, smokers tended to have worse pain interference, fatigue, sleeprelated impairment, anger, emotional support, and depression over time compared to non-smokers. Patients with chronic pain who smoke have worse pain, functional, sleep, and psychological and mood outcomes compared to non-smokers. Smoking also has prognostic importance for poor recovery and improvement over time. Further research is needed on tailored therapies to assist people with chronic pain who smoke and to determine an optimal strategy to facilitate smoking cessation.

View details for DOI 10.1097/j.pain.0000000000001631

View details for PubMedID 31149975