Pain Status as a Predictor of Smoking Cessation Initiation, Lapse, and Relapse

Nicotine Tob Res. 2021 Jan 7;23(1):186-194. doi: 10.1093/ntr/ntaa111.


Introduction: Pain and cigarette smoking are highly prevalent and frequently co-occurring conditions that interact in the manner of a positive feedback loop. Despite initial evidence that smokers with co-occurring pain may experience greater difficulty quitting, we are unaware of previous research that has tested prospective associations between pain status and the attainment of smoking cessation milestones.

Aims and methods: This study examined past 2-week pain status as a predictor of cessation milestones among current smokers who were motivated to quit (Sample 1; N = 301) and smokers who recently initiated a cessation attempt (Sample 2; N = 242). Cessation milestones included initiation of a quit attempt and 7-day point prevalence abstinence (PPA; Sample 1), lapse/relapse (Sample 2), and 7-day PPA at 2-month follow-up (both samples). Indirect associations between pain status and cessation milestones via confidence in quitting and nicotine withdrawal were also examined.

Results: Smokers with pain (vs. no pain) were as follows: less likely to initiate a quit attempt and achieve 7-day PPA; more likely to lapse and/or relapse; and less likely to report 7-day PPA at follow-up. Pain status was indirectly associated with latency cessation milestones via confidence in quitting and with latency to lapse via withdrawal severity.

Conclusions: This study demonstrated that pain status can predict smoking cessation outcomes. Clinical implications include the need to assess pain in the context of quitting and that smokers with co-occurring pain may benefit from tailored/integrated cessation interventions.

Implications: A growing empirical literature indicates that the presence of co-occurring pain probably contributes to the maintenance of cigarette dependence. The current results provide novel evidence that smokers with co-occurring past 2-week pain are less likely to initiate a quit attempt and maintain smoking abstinence than smokers without co-occurring pain. These findings suggest that smokers with pain face unique barriers to quitting and underscore the utility of assessing and addressing pain among all smokers who are planning a smoking cessation attempt.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Health Behavior*
  • Humans
  • Male
  • Motivation
  • Pain / physiopathology*
  • Prospective Studies
  • Recurrence
  • Smokers / psychology*
  • Smoking / epidemiology*
  • Smoking / psychology
  • Smoking Cessation / psychology*
  • Smoking Cessation / statistics & numerical data
  • South Carolina / epidemiology
  • Substance Withdrawal Syndrome / diagnosis*
  • Substance Withdrawal Syndrome / epidemiology
  • Substance Withdrawal Syndrome / psychology