Anxiety and Depression in Bidirectional Relations Between Pain and Smoking

Abstract

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.

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

“…Based on these data, we would hypothesize that as pain becomes increasingly linked with the self-administration of nicotine to ameliorate pain, the pain experience itself may gain salience as a conditioned interoceptive cue for tobacco smoking. Consistent with theoretical conceptualizations of allostatic load among chronic substance users [29; 30], smokers may become sensitized to the pain experience and evince greater pain reactivity (i.e., hyperalgesia) during the early stages of nicotine withdrawal, which in turn, could motivate relapse to smoking [15; 22; 70; 84]. …”

“…Chronic pain and tobacco addiction are both highly prevalent and comorbid disorders that likely interact in a bi-directional manner [22; 84]. 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].…”

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

“…Tobacco addiction and chronic pain are both highly prevalent and co-occurring disorders that have been hypothesized to operate in the manner of a positive feedback loop, resulting in greater pain and the maintenance of smoking behavior (Ditre, Brandon, Zale, & Meagher, 2011; Zale, Maisto, & Ditre, 2016). 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).…”

Common health problems in safety‐net primary care: Modeling the roles of trauma history and mental health

“…Patients of low socioeconomic status are more likely to experience both acute and chronic pain, although some studies suggest that this link is better explained by psychological factors than by poverty‐related environmental risks (K. A. Davies et al, ). The link between mental health and chronic pain is well‐established throughout the literature: anxiety and depression increase the likelihood of chronic pain (Currie & Wang, ; Ohayon & Schatzberg, ; Zale, Maisto, & Ditre, ) and are associated with worse pain management (Bair, Robinson, Katon, & Kroenke, ; Dersh, Polatin, & Gatchel, ). Trauma exposure is a less‐established risk factor for chronic pain, as research findings have been mixed.…”

“…Davies et al, 2009). The link between mental health and chronic pain is well-established throughout the literature: anxiety and depression increase the likelihood of chronic pain (Currie & Wang, 2004;Ohayon & Schatzberg, 2003;Zale, Maisto, & Ditre, 2016) and are associated with worse pain management (Bair, Robinson, Katon, & Kroenke, 2003;Dersh, Polatin, & Gatchel, 2002). Trauma exposure is a lessestablished risk factor for chronic pain, as research findings have been mixed.…”