Smoking Status and Pain Level Among Head and Neck Cancer Patients

J Pain. 2010 Jun;11(6):528-34. doi: 10.1016/j.jpain.2009.09.006. Epub 2009 Dec 16.


Smoking is a risk factor for cancer of the upper aerodigestive tract with recidivism rates high even after diagnosis. Nicotine, a major product in tobacco, is a complex drug with multiple characteristics including analgesic properties. The goal of the study was to examine pain levels in the context of smoking status among patients recently diagnosed with cancer of the upper aerodigestive tract who have not yet received any treatment including radiation, surgery, or chemotherapy. A convenience sample of 112 newly diagnosed head and neck cancer patients (78 men and 34 women) was recruited from clinics at the University of Florida. Smoking rates were: 32% never smoked, 34% former smokers, 34% current smokers. Among current smokers, 62% reported plans to quit in the next 3 months and 38% had tried to quit more than 3 times in the past 5 years. Current smokers reported higher general (sensory and affective) and oral pain levels (spontaneous and functional) and pain-related interference than did never and former smokers (all F's > 8. and P's < .0001) even after controlling for stage of diagnosis. In addition, current smokers reported significantly greater interference from the pain (F(2,73) = 10.5 P < .0001).

Perspective: This study highlights the importance of understanding self-reported pain in cancer patients who continue to smoke. When pain is elevated, smokers may be motivated to use tobacco as a means of reducing pain, which in turn reinforces smoking behavior. Tobacco cessation programs should include pain management as a component of treatment.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analysis of Variance
  • Female
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / psychology*
  • Humans
  • Male
  • Middle Aged
  • Pain / psychology*
  • Severity of Illness Index
  • Smoking / psychology*
  • Smoking Cessation