Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients

Pain Med. 2015 Jul;16(7):1433-42. doi: 10.1111/pme.12747. Epub 2015 Mar 20.


Objective: As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes.

Methods: Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia.

Results: Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference.

Conclusions: Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge.

Keywords: Chronic Pain; Depression; Fibromyalgia; Tobacco Smoking.

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / psychology*
  • Chronic Pain / therapy
  • Depression / psychology*
  • Female
  • Fibromyalgia / psychology*
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement / methods
  • Prevalence
  • Quality of Life / psychology*
  • Severity of Illness Index
  • Smoking / psychology*
  • Surveys and Questionnaires