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The following is a summary of “Ecological momentary assessment of cigarette smoking behavior and pain intensity among individuals with chronic back pain who smoke,” published in the January 2025 issue of Pain by Rubenstein et al. 

Chronic pain, affecting approximately 20% of the adult population, was associated with smoking, but the short-term relationships between smoking and pain throughout the day remained unclear.  

Researchers conducted a retrospective study to explore the short-term associations between smoking and pain in individuals with chronic back pain, utilizing ecological momentary assessment (EMA) to capture real-time data on smoking urges, intentions, and recency.  

They delivered EMA prompts 5 times daily to participants with chronic back pain who smoke, with an 81.5% response rate. Independent variables were, urge to smoke (scale 1-9), intention to smoke (about to smoke or not about to smoke), and smoking recency (smoked <30 minutes or >30 minutes ago). Smoking now was treated separately in models 2 and 3. The multi-level models, including an interaction term with the Pain and Smoking Inventory (PSI) score, were used to estimate associations with pain intensity (scale 1-9).  

The results showed the urge to smoke increased pain intensity (β=0.10 [SE=0.02], P <0.001), with a stronger effect in individuals with higher PSI scores (β=0.03 [0.01], P =0.003). Not being about to smoke was associated with lower pain intensity than smoking now (β=-0.29 [0.09], P =0.001). Smoking within 30 minutes (β=-0.30 [0.09], P =0.001) and over 30 minutes ago (β=-0.23 [0.11], P =0.029) were also linked to lower pain intensity compared to smoking now.  

Investigators concluded the complex interplay between smoking urges, pain perception, and perceived smoking-pain relationships warrants further research into integrated interventions combining tailored smoking cessation and behavioral pain management strategies. 

Source: jpain.org/article/S1526-5900(25)00002-1/abstract