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30.08.2021 | original article | Ausgabe 19-20/2021

Wiener klinische Wochenschrift 19-20/2021

I smoke to cope with pain: patients’ perspectives on the link between cigarette smoking and pain

Wiener klinische Wochenschrift > Ausgabe 19-20/2021
BS Megan Lee, MSc Jennifer Snow, BS Caroline Quon, MS Kim Selander, MPH Eric DeRycke, MSW Mark Lawless, PhD Mary Driscoll, PhD Joseph W. Ditre, PhD Kristin M. Mattocks, MD William C. Becker, MD MPH Lori A. Bastian
Wichtige Hinweise


The opinions expressed here are those of the authors and do not represent the official policy or position of the U.S. Department of Veterans Affairs or the U.S. government.

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For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized a reciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association.


A retrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, a tailored smoking cessation trial, was conducted. A validated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in a consensus-forming exercise with salient themes validated among the wider research team.

Key results

Participants averaged 60 years of age (range 28–77 years) and were 9% female. The median number of cigarettes smoked per day was 15, with a mean pain intensity score in the last week (from 0–10) of 5.1. While not all patients acknowledged a connection between pain and smoking, we found that (1) pain motivates smoking and helps manage pain-related distress, as a coping strategy and through cognitive distraction, and (2) pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as a notable barrier to cessation.


Many patients with chronic pain who smoke readily identified pain as a motivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain.

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