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Smokers light up after pain

A new study has demonstrated that pain can increase the desire to smoke cigarettes.

The study, conducted by researchers from USF and the H. Lee Moffitt Cancer Center and Research Institute, could have important implications for smokers who suffer from chronic pain.

In the May issue of the Journal of Abnormal Psychology, researchers Joseph W. Ditre, a doctoral candidate in clinical psychology at USF, and Thomas H. Brandon, a USF professor and director of Moffitt’s Tobacco Research and Intervention Program, wrote that the prevalence of smoking among people with chronically painful conditions, such as rheumatoid arthritis, is approximately double that of the general population.

Although other studies have associated smoking with the development and aggravation of chronic pain, Ditre and Brandon’s research investigated the link between smoking and pain from a different angle.

Rather than examining smoking as a possible contributing cause or aggravator of chronic pain conditions, they tested whether the pain itself may promote increased or continued smoking. If pain stimulates the desire to smoke, and smoking exacerbates painful conditions, then smokers with chronic pain get caught in a devastating cycle that can worsen their pain while maintaining and even increasing their dependency on cigarettes.

“With smoking so prevalent among people with chronic pain, it was important to provide experimental evidence that pain can be a strong motivator of smoking,” Ditre said. “That hadn’t been done before.”

The experiment consisted of 132 adults who smoke at least 20 cigarettes a day. Half of the participants underwent a pain-induction procedure by immersing their non-dominant hands in a circulating cold-water bath (0 degrees to 1 degree Celsius) until the pain became intolerable. The other half immersed their non-dominant hands in room-temperature water.

After removing their hands from the water, participants completed questionnaires aimed to elicit their urges to smoke. They were then given the opportunity to have a cigarette.

Participants who experienced the painful cold-water procedure reported worse moods and greater urges to smoke than before the procedure. They were also quicker to smoke than those in the non-pain group.

From the experiment, Brandon and Ditre hypothesized that the participants used smoking as a way to ease the pain.

“Pain has a negative impact on mood state,” Brandon said, “and that could be part of the mechanism at work when smoking is motivated by pain. But what is significant about this particular study is that it shows scientifically that situational pain does in fact motivate smoking. Future studies can build from this.”

Ditre said that this research points out a new direction for science to investigate. He also said a systematic analysis of the link between pain and smoking motivation would be an appropriate next step.

“Further research into this area may help provide a greater understanding of smoking addiction within the chronic pain population,” Ditre said. “And smoking-cessation treatments may benefit from that research.”

The evidence presented in the study could be another step toward helping people overcome a self-defeating loop in which many chronic-pain sufferers cannot quit smoking because they use cigarettes to ease their pain, Brandon said.