Enhanced pain perception prior to smoking cessation is associated with early relapse
Highlights
► We tested whether pain ratings prior to smoking cessation predicted early relapse. ► Pain ratings were related to increased risk for early smoking relapse. ► The finding remained significant after controlling for stress-related variables. ► Pain perception may be helpful in identifying smokers at risk for early relapse.
Introduction
Nicotine produces hypoalgesia (Kanarek and Carrington, 2004, Lane et al., 1995, Rau et al., 1993). Smokers may become vulnerable to physical discomfort during acute smoking withdrawal when nicotine effects are diminished. One recent study found that smokers who completed the cold pressor task reported increased smoking urges and showed shortened latency to smoke after the task (Ditre and Brandon, 2008). Also, individual differences in distress tolerance are related to risk for relapse (Brown et al., 2009). Smokers who are sensitive to pain prior to a cessation attempt may become particularly responsive to distress-related symptoms during abstinence and vulnerable to early smoking relapse. However, whether pre-cessation pain ratings are associated with enhanced risk for smoking relapse has not been directly examined.
While experiments on rats suggest that nicotine's antinociceptive effect is subject to tolerance (McCallum et al., 1999, Wewers et al., 1999), other studies indicate that withdrawal is associated with rapid reversal of this tolerance (Anderson et al., 2004, Mousa et al., 1988, Pomerleau et al., 1984, Silverstein, 1982). In one study, pain-attenuating effects of smoking a cigarette were greater in smokers deprived from smoking overnight (12 h) relative to those who smoked ad libitum (Pauli et al., 1993). These results are consistent with the increased discomfort smokers experience during the early stages of abstinence (Drobes et al., 1994, Pomerleau, 1992). Since enhanced withdrawal symptoms are associated with early smoking relapse (al’Absi et al., 2004), absence of nicotine-related analgesia may represent a risk factor contributing to early smoking relapse.
Although nicotine's analgesic effect is a fairly consistent finding in animals and humans, some exceptions do exist (Knott, 1990, Nesbitt, 1973, Silverstein, 1982, Sult and Moss, 1986). These inconsistent findings may have resulted from methodological differences such as smoking selection criteria, length of abstinence, and pain assessment procedures. For instance, pain reports obtained during the actual exposure to a noxious stimulus yield results different from reports obtained afterward, and subsequently group differences may depend on whether pain reports were obtained during or after exposure to the noxious stimulus (al’Absi et al., 2002, France et al., 1994). Some studies suggest that retrospective reports of pain are influenced by what the individual experienced at the end of the painful task (al’Absi et al., 1996, Fredrickson and Kahneman, 1993, Khaneman et al., 1993) and how the individual coped with the pain (Burns et al., 2004, Burns et al., 2007, Cioffi and Holloway, 1993). These suggest that the timing (e.g., simultaneous or retrospective) of pain assessment may have different patterns of prediction for smoking relapse.
The purpose of the current study was to examine the extent to which pain perception prior to smoking cessation predicted early relapse. Also, we tested if pain ratings during and after cold pressor test (CPT) had different prediction patterns of relapse. Measures on pain perception, mood changes, heart rate, blood pressure, and cortisol were collected prior to a cessation attempt and were evaluated as predictors of relapse over a 4-week period. We hypothesized that increased pain ratings during and after CPT would be associated with increased risk for early relapse.
Section snippets
Participants
Smokers were recruited through newspaper advertisements in the community and flyers in the university. Interested participants completed a phone interview that consisted of questions on current history of medical or psychiatric disorders, medication intake, and smoking behavior. Participants must have smoked an average of 10 cigarettes or more per day at least for 2 years, and a strong desire for quitting smoking (i.e., required to report the score of 4 (strong) or higher to the question “On a
Demographic and smoking variables
Nineteen smokers (27%) relapsed by the first week post-quit, 30 (42%) smokers relapsed by the end of the second week, and 36 smokers (51%) returned to smoking by the 4-week follow up. As shown in Table 1, abstinent and relapsed groups did not differ in age, body mass index, education, caffeine intake, average number of hours of sleep, number of daily cigarettes, duration of smoking, previous quit attempts, or motivation to quit (ps > .24). The relapsed group had a marginally higher FTND score
Discussion
The results of the current study clearly demonstrated that pain ratings during and after CPT prior to cessation of smoking were associated with early smoking relapse. The findings also support the hypothesis that individuals who are low in distress tolerance are at risk for early relapse (Brown et al., 2009). In addition, the results of our study extend previous findings (Ditre and Brandon, 2008) by examining individual differences in pain perception prior to smoking cessation, and in that
Acknowledgments
We thank Koji Fujiwara for assistance with data analysis. This research was supported in part by a grand to Dr. al’Absi from the National Cancer Institute (CA 88272). Dr. al’Absi was also supported by grants from the National Institute on Drug Abuse (DA 013435 and DA 016351). The authors have no conflicts of interest regarding this manuscript.
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