Smoking to Cope with Pain: The Motivating Effects of Pain Induction on Smoking Urge and Behaviour
Millions of Canadians live with chronic pain. Substantial evidence has linked tobacco smoking with both acute and chronic pain conditions. Contemporary models of pain and smoking posit a cyclical relationship wherein individuals smoke to reduce pain in the short term; however, smoking to cope with pain indirectly exacerbates pain in the long term. Recent findings suggest situational pain is sufficient to increase smoking urge and immediate smoking behaviour (Ditre & Brandon, 2008). The purpose of the current investigation is to replicate and extend the findings of Ditre and Brandon (2008) by investigating the effects of (a) situational pain on smoking urge and behaviour using a reliable pain induction technique (electrical stimulation) and an alternate thermal mode (heat), and (b) anxiety vulnerabilities and smoking expectancies that may be contributing to increased tobacco dependence in a university and community sample (n=34; 55.9% male). Participants were randomly assigned to a heat pain or no pain control condition. Pre-manipulation group differences occurred in the Anxiety Sensitivity Index-3 (ASI-3) social subscale. A series of 2 x 2 ANCOVAs were conducted using pain (heat pain, no pain) and sex (female, male) as the two independent variables, self-reported urge to smoke and immediate smoking behaviour as the dependent variables, and the ASI-3 social subscale as the covariate. Participants in the heat pain group reported significantly greater smoking urge and more immediate smoking behaviour than those in the no pain group. Individuals with higher levels of ASI-3 social reported greater smoking urge and more immediate smoking behaviour. Further, results of a chi-square difference test indicated significantly more individuals in the heat pain group attempted to smoke (100%) after the pain manipulation than those in the control group (62.5%). Structural equation modeling was conducted to assess direct and indirect relationships of the aforementioned variables (i.e., smoking urge, immediate smoking behaviour, ASI-3 social) along with smoking expectancies related to craving/addiction. The model demonstrated excellent fit to the data. Results of the current investigation provide support for the findings of Ditre and Brandon (2008), indicating that situational pain is sufficient to increase both smoking urge and immediate smoking behaviour. Current results also indicate a role of the ASI-3 social subscale as well as smoking expectancies related to craving/addiction in the reciprocal relationship between pain and smoking. Findings suggest the necessity for comprehensive assessment of pain-related vulnerabilities and smoking expectancies that may lead to increased nicotine dependence in individuals seeking treatment for injury as well as chronic pain.
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Faculty of Graduate Studies and Research, University of Regina