UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Pain Management | Psychiatry and Psychology | Substance Abuse and Addiction


BACKGROUND: 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.

METHODS: 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.

CONCLUSION: 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.


Chronic pain, Coping strategy, Qualitative research, Smoking cessation, Tobacco

Rights and Permissions

Copyright © 2021, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply

DOI of Published Version



Lee M, Snow J, Quon C, Selander K, DeRycke E, Lawless M, Driscoll M, Ditre JW, Mattocks KM, Becker WC, Bastian LA. I smoke to cope with pain: patients' perspectives on the link between cigarette smoking and pain. Wien Klin Wochenschr. 2021 Oct;133(19-20):1012-1019. doi: 10.1007/s00508-021-01931-x. Epub 2021 Aug 30. PMID: 34460005. Link to article on publisher's site

Journal/Book/Conference Title

Wiener klinische Wochenschrift

PubMed ID


Related Resources

Link to Article in PubMed