Background: Pain and tobacco use frequently co-occur in the general population; however, less is known about whether these relationships extend to cancer survivors, who report high levels of chronic pain.
Purpose: This scoping review aimed to inform future research by identifying, characterizing, and synthesizing the research literature on pain and nicotine/tobacco use among cancer survivors.
Methods: We developed and executed a comprehensive search strategy in December 2023 and September 2024, identifying 5901 peer-reviewed citations after systematic search of Embase (Elsevier), MEDLINE (Ovid), PsycINFO (EBSCO), Cochrane Library (Wiley), and ClinicalTrials.gov. Fifty-four studies published from 2004 to 2024 met inclusion criteria.
Results: Most studies focused on combustible cigarette smoking (∼94%), and minimal research focused on treatment and tobacco cessation. Approximately half (n = 27) of studies were prospective/longitudinal in design, followed by cross-sectional (n = 25), qualitative (n = 1), and a pilot randomized controlled trial (n = 1). Most studies (∼74%) demonstrated a positive relationship between pain and cigarette/tobacco use. Former smoking was linked to lower pain levels, although findings were more mixed in this area. Only 2 studies found a negative relationship between pain and tobacco use.
Conclusions: This review demonstrates that associations between pain and cigarette smoking in cancer survivors are the same as those found in the general population. Future research would benefit from: (1) incorporating more rigorous designs capable of determining causality, (2) focusing on use of other nicotine/tobacco products (eg, electronic cigarettes), (3) elucidating mechanisms in pain and tobacco use, and (4) considering impact of pain on smoking cessation and treatment among cancer survivors.
Keywords: cancer; cigarettes; e-cigarettes; nicotine; pain; tobacco.
The goal of this scoping review was to characterize existing research on pain and tobacco use among cancer survivors. Pain and tobacco use frequently co-occur in the general population, but less is known whether these relationships extend to cancer survivors, who report high levels of chronic pain which can last for years after treatment. Fifty-four studies were identified. Almost all studies (94%) focused on cigarette smoking. Overall, results demonstrated that pain is related to tobacco use among cancer survivors, such that cancer survivors who continue to smoke cigarettes report experiencing more intense pain, greater interference/disability from pain, and are more likely to meet criteria for chronic pain. Conversely, experiencing more intense pain may drive smoking. Quitting smoking was linked to lower levels of pain, although findings in this area were less conclusive. These findings highlight the importance of understanding the connection between tobacco use and pain among cancer survivors, and there is a need to identify whether pain is related to use of other types of nicotine/tobacco products (eg, electronic cigarettes). Given the negative impact of smoking both on pain and cancer recurrence/morbidity, it is also important to develop integrated pain and tobacco cessation treatments among cancer survivors.
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