The effects of depression and smoking on pain severity and opioid use in patients with chronic pain

Abstract

Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (N = 1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P = 0.001) and clinical pain (P = 0.001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P = 0.005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27 mg/day), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids.

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

“…32 Opioids may also be less effective among individuals with mood disturbance, including depression, anxiety, and catastrophic thinking, as well as patients who suffer from fibromyalgia, neuropathic pain, and psychiatric disease. 33–36 …”

Incidence and Risk Factors for Progression From Short-term to Episodic or Long-term Opioid Prescribing

“…For nicotine, smokers with chronic pain are more likely to use opioids and consume greater quantities of opioids compared to nonsmokers with chronic pain independent of pain severity and depression. 22–24 Furthermore, a reciprocal relationship has been observed between opioid and nicotine consumption; increases in opioid use have been associated with increases in nicotine use, and increases in nicotine use have been associated with increases in opioid consumption. 25–27 Preclinical studies suggest the antinociceptive effects of nicotine and morphine are linked, and that morphine-related antinociception is influenced by activation of supraspinal nicotinic acetylcholine receptors.…”

Tobacco Smoking, Nicotine Dependence, and Patterns of Prescription Opioid Misuse: Results From a Nationally Representative Sample

“…32,33 Treatment-seeking pain patients who endorse smoking to cope with pain have evinced greater reliance on opioid medications, 35 and smokers (compared to nonsmokers) may be less likely to complete pain treatment that requires opioid tapering. 36 In addition, there is some evidence that smoking behavior may be influenced by consumption of prescription opioids, 37 and persons who use opioid medications for pain management may be more likely to smoke tobacco.…”