LAWRENCE — New research from the University of Kansas shows people who experience chronic pain tend to consume cigarettes and e-cigarettes at higher rates than others. The findings, based on analysis of the National Health Interview Survey from 2014-2023 , should inform therapies for both chronic pain and smoking cessation.
The study appears in the American Journal of Preventive Medicine.
“People get caught in this really vicious cycle where pain is driving smoking, smoking makes the pain worse, which makes it really hard to quit,” said co-author Jessica Powers, assistant professor of psychology at KU. “We know pain drives tobacco use. Tobacco has short-term pain-relieving properties, so a lot of people find it helpful in the moment, but it actually causes negative effects in the long term. Tobacco smoking can actually make pain worse and make you more likely to develop a chronic pain condition.”
Powers, who also serves as assistant scientist with the KU Life Span Institute’s Cofrin Logan Center for Addition Research & Treatment , said there’s a growing understanding that chronic pain relates to substance-use disorders and addiction.
“In our case, we’re seeing a lot of data showing that those with chronic pain are much more likely to use tobacco — cigarettes, e-cigarettes and other types of nicotine or tobacco products,” she said.
Powers and her colleagues analyzed responses from more than 195,600 Americans surveyed over 10 years. The key finding: Chronic pain is tied to smoking and vaping at higher rates.
“Smoking tends to make everything worse,” Powers said. “We see impacts on mental health. As a pain psychologist, when I work directly with patients, we talk about smoking as a way to cope with the lower mood that comes with living with chronic pain, not being able to get out of the house or do things that are important to them. That coping strategy tends to make everything worse. We talk about it as a cycle involving pain, addiction, mood and functioning.”
While fewer Americans are smoking overall, the reduction is declining more slowly in people with chronic pain, the study shows.
“We know that cigarette smoking rates overall are going down, which is good,” Powers said. “But what these results show is that the decline isn’t happening as fast for people with chronic pain. People with chronic pain are about twice as likely to smoke cigarettes and to use other types of tobacco products, including e-cigarettes, and to use multiple products together.”
Furthermore, the KU researcher said people with chronic pain are more likely to vape e-cigarettes.
“There’s a lot of complexity with e-cigarettes,” she said. “On the one hand, an e-cigarette is going to be a less harmful product than a combustible product. You’re not getting all the carcinogens from smoking. But we also have reason to believe that nicotine and the way it works on our pain system might also make pain worse. In folks with pain, we’re not quite sure yet what level of harm we may be seeing from e-cigarettes.”
The data also revealed more frequent or disabling pain was tied to a higher likelihood of tobacco smoking.
“You can think about this in two ways,” Powers said. “Smoking may be making pain worse and increasing the likelihood of high-impact chronic pain. At the same time, people with greater pain impact are more likely to turn to cigarettes as a way to cope. When pain interferes with seeing grandchildren or doing meaningful activities, negative mood increases. All of those things may drive further smoking as a coping mechanism.”
Powers said the takeaway from her research for clinicians and policymakers is people with chronic pain are being left behind
“We know that cigarette smoking rates overall are going down, which is good,” she said. “But what these results show is that the decline isn’t happening as fast for people with chronic pain.”
Powers’ collaborators were Julianna Lazzari and Dana Rubenstein of the Duke University School of Medicine, joined by F. Joseph McClernon and Maggie Sweitzer, also of the Duke University School of Medicine in Durham, North Carolina. Additional co-authors included Lauren Pacek of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.
Moving forward, Powers thinks the results should inform clinical interventions for those living with chronic pain and looking to quit tobacco.
“I’m a licensed clinical psychologist and worked in addiction and pain settings,” she said. “When I was doing intensive outpatient treatment groups for people early in withdrawal, pain came up frequently in clinical work. The goal of my research is to develop smoking cessation interventions that incorporate pain management for people with chronic pain. We have great pain treatments and great smoking cessation treatments, but we need to put them together.”
Powers recently earned a K12 Paul Calabresi Career Development award from the KU Cancer Center to develop a pain management and smoking cessation program for cancer survivors.