The Association of Current Tobacco Status With Pain and Symptom Severity in Fibromyalgia Patients

Abstract

Objective: To describe current tobacco use among patients with newly confirmed fibromyalgia and evaluate the association between tobacco use status and severity of reported pain and other fibromyalgia symptoms.Patients and Methods: Participants in this study were adult patients (N¼1068) with fibromyalgia who met American College of Rheumatology 2010/2011 clinical criteria for fibromyalgia at the time of initial presentation to a Midwest fibromyalgia clinic (June 1, 2018, through May 31, 2019). Multiple linear regression analyses were performed to assess the association of tobacco use status with the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores. Covariates included in these analyses included age, sex, body mass index, depression, opioid medication use, and use of fibromyalgia-specific pharmacotherapy. Results: The patients were largely women (87.0%; n¼929), white (87.9%; n¼939), and with an average AE SD age of 46.6AE13.9 years. The WPI and SSS scores were significantly greater in current tobacco users compared with never tobacco users (WPI effect estimate [EE] ¼ 1.03; 95% CI, 0.30 to 1.76; type III P¼.020; SSS EE ¼ 0.47; 95% CI, 0.11 to 0.84; type III P¼.036). The WPI score was negatively associated with age (EE ¼ À0.02 per year; 95% CI, À0.03 to À0.001 per year; P¼.037) and no use of opioid medication (EE ¼ À1.08; 95% CI, À1.59 to À0.57; P<.001) while positively associated with higher body mass index (EE ¼ 0.03 per 1 kg/m 2 ; 95% CI, 0.001 to 0.06 per kg/m 2 ; P¼.04) and higher Patient Health Questionnaire-9 score (EE ¼ 0.12; 95% CI, 0.08 to 0.16; P<.001). Conclusion:The results of our study suggest that tobacco use is associated with greater pain and other symptom severity in patients with fibromyalgia. These findings have important clinical and research implications for patients with fibromyalgia who use tobacco and who may benefit from early identification and timely implementation of tobacco cessation treatment to decrease pain and improve overall quality of life.

Development of Opioid Use Disorder After Breast Reconstruction

“…26,27 It may also provide insight for the association between tobacco use and hypersensitivity syndromes such as fibromyalgia. 28 Other than increasing opioid metabolism, smoking may also contribute to increased risk of OUD because it decreases tissue oxygenation, reduces fibroblast migration, and downregulates collagen synthesis and deposition. These changes prolong the healing process, thus providing an opportunity for prolonged opioid use.…”

“…This may explain why smokers are more likely to require long-term opioid therapy and develop OUD than the general population 26,27 . It may also provide insight for the association between tobacco use and hypersensitivity syndromes such as fibromyalgia 28 . Other than increasing opioid metabolism, smoking may also contribute to increased risk of OUD because it decreases tissue oxygenation, reduces fibroblast migration, and downregulates collagen synthesis and deposition.…”

Quality of life in patients with fibromyalgia: Contributions of disease symptoms, lifestyle and multi-medication

“… Pamuk et al (2009) and Lee et al (2011) found that smoking was associated with some psychological factors such as depression, anxiety, and fatigue in FM patients. Tobacco use has been associated with worse QoL in two studies that surveyed large samples of patients with FM ( Ge et al, 2019 ; Croghan et al, 2021 ). In this regard, it is important to highlight the research carried out by Zale et al (2014) , who found that patients with chronic pain view smoking as a way of coping with pain and even think that abstinence might interfere with pain management.…”

“…In this vein, physical activity in FM was positively related to brain responses generated during pain distraction, whereas sustained sedentary behavior was negatively associated with pain regulation ( Ellingson et al, 2012 ). In the other hand, in two recent studies ( Ge et al, 2019 ; Croghan et al, 2021 ) that surveyed large samples of patients with FM (668 and 1068, respectively), tobacco use was also associated with greater pain and other symptom severity, and with worse QoL.…”

The prevalence of fibromyalgia among doctors in the tertiary care hospital: A cross-sectional study

“…The probable mechanisms explain that tobacco smoking affects cognitive function as due to extreme pain sensitization, it consumes the neurotransmitters, thus decreasing the neural resources needed for cognitive function [ 26 ]. Nicotine is indicated in causing derangements of neurotransmitters, including dopamine, serotonin, and noradrenaline, leading to defective pain modulation [ 27 ].…”