Background & Aims
Tobacco smoking and chronic pain are highly comorbid and are proposed to influence each other through a reciprocal positive feedback loop. Nicotine has mild analgesic effects that may contribute to negative reinforcement from smoking, whereas initial smoking abstinence leads to increased pain that is correlated with craving and withdrawal. Thus, despite perceptions that smoking helps people to cope with pain, fluctuating nicotine levels may actually exacerbate pain. Very low nicotine content (VNLC) cigarettes decrease nicotine dependence and cigarettes smoked per day but have not been investigated in the context of chronic pain. Here, we present preliminary data from an ongoing trial in which people who smoke with chronic back pain are assigned to 4 weeks of VLNC vs normal nicotine investigational cigarettes. Although group assignment is blinded, we examined whether changes in dependence and cigarettes per day over the 4-week period correlate with changes in subjective pain ratings.
Methods
People who smoke with chronic back pain (n=30) who were not seeking to quit smoking attended 5 weekly visits (V1-V5). After V1 participants were randomized (double-blind) to smoke only VLNC or normal nicotine cigarettes for 4 weeks. Compliance with study cigarettes was incentivized and biochemically verified with urine cotinine. At each visit participants completed the Brief Pain Inventory, a measure of nicotine dependence, and reported cigarettes smoked per day. At V1 and V5, participants completed the Pain and Smoking Inventory assessing beliefs that pain motivates smoking and smoking helps cope with pain, as well an 11-item Pain Self-Efficacy Scale. Three months after study completion participants were contacted and asked about recent smoking. Difference scores from V1 to V5 were calculated for each measure to examine correlations between changes in smoking and pain-related variables. Logistic regression then examined associations between reduction in pain and smoking at follow-up.
Results
At V1 participants smoked an average of 15.5 (±5.8) cigarettes per day and rated their past-week pain intensity as 4.7 (±1.7) out of 10. Individuals exhibiting a decrease in nicotine dependence from V1 to V5 reported a corresponding 1) decrease in pain intensity (r=.50, p<.01) and unpleasantness (r = .65, p<.001), 2) decrease in scores on the Pain and Smoking Inventory (r=.57, p<.005) and 3) increase in pain self-efficacy (r=-.57, p<.005). Change in cigarettes per day was unrelated to change in any pain measure. From V1 to V5, 8 individuals (27%) showed a clinically meaningful reduction in pain intensity, defined as a decrease of ? 30%. Among participants with available follow-up data (n=21), those with clinically meaningful pain reduction were more likely to have quit smoking than those without (67% vs 15%, respectively), even when controlling for change in dependence (B=2.5, p<.05). Baseline pain intensity, cigarettes per day and dependence were unrelated to follow-up smoking status.
Conclusions
Our preliminary results suggest that cigarette dependence tracks with measures of pain among people who smoke with chronic back pain. Although VLNCs carry the same health risks as normal nicotine cigarettes, they reduce dependence and increase the likelihood of making a quit attempt; as such, they may serve as an intermediate step toward cessation for people initially unable to quit. Given the reciprocal links between nicotine use and pain, it is unknown if nicotine reduction in cigarettes will lead to a) increased pain due to withdrawal and loss of analgesic effects; b) decreased pain due to reduced dependence and stabilization of the cycle of craving, smoking and withdrawal; or c) no change. Our results provide preliminary evidence that short-term change in nicotine dependence relates to meaningful change in pain intensity and decreased reliance on smoking to cope with pain. Future analyses will determine if results are maintained in the full sample are due to group assignment.
References
1.Ditre JW, Heckman BW, LaRowe LR, Powers JM. Pain Status as a Predictor of Smoking Cessation Initiation, Lapse, and Relapse. Nicotine Tob Res. 2020.
2.Ditre JW, Zale EL, LaRowe LR, Kosiba JD, De Vita MJ. Nicotine deprivation increases pain intensity, neurogenic inflammation, and mechanical hyperalgesia among daily tobacco smokers. J Abnorm Psychol. 2018;127(6):578-589.
3.Donny EC, Denlinger RL, Tidey JW, et al. Randomized Trial of Reduced-Nicotine Standards for Cigarettes. N Engl J Med. 2015;373(14):1340-1349.
Presenting Author
Maggie Sweitzer
Poster Authors
Topics
- Mechanisms: Psychosocial and Biopsychosocial