(338) Pain and motivation to smoke tobacco: Experimental findings and a theoretical conceptualization

Abstract

The prevalence of smoking among chronic pain patients is twice that of the general population. Despite evidence that smokers are at risk for developing and exacerbating painful conditions, yet consistent with evidence of smoking-related analgesia, most patients report a need to smoke when in pain, and correlations between pain intensity and cigarettes smoked have been reported. The purpose of this study was to determine whether cold-pressor pain would enhance motivation to smoke tobacco. Smokers were randomly assigned to either pain or no pain conditions. Results indicated that pain increased urge ratings (p < .001) and produced shorter latencies to smoke (p = .03), with increased urge ratings partially mediated by negative affect (p < .001). This study provides the first experimental evidence that situational pain is a potent motivator of smoking. Comprising the literature to date, we conceptualize a potentially reciprocal relationship between pain and smoking that acts as a positive feedback loop, with the end result being increases in both pain and smoking. We propose that smokers who are motivated to use tobacco to cope with or assuage pain may unwittingly aggravate their painful condition by increasing their cigarette consumption, thus engendering a vicious cycle that could lead to greater nicotine dependence. We are currently testing the causal relationship between pain and smoking motivation by manipulating potential mediating (use of pain-related coping behaviors) and moderating variables (smoking-related outcome expectancies), as influenced by social learning theory-based conceptualizations of pain coping and addiction motivation. This 2X2 crossed-factorial design will also provide an analogue test of variables that may influence interventions for individuals with comorbid pain and addiction disorders. PURPOSE: The ultimate goals of this line of research are to better understand the relationship between smoking and chronic pain, and to develop smoking-related interventions for individuals in pain.