The bidirectional relationship between pain and tobacco use: Insights from the longitudinal Population Assessment of Tobacco and Health (PATH) study.

Background: Tobacco smoking remains the leading preventable cause of death, whereas chronic pain is the leading cause of disability. Chronic pain and tobacco smoking are closely interrelated. We investigated whether pain predicts daily cigarette smoking and if daily cigarette smoking predicts the development of pain.

Methods: We analyzed eight years of longitudinal data from the Population Assessment of Tobacco and Health study. We examined whether baseline pain (scored ≥4 on a 0-10 scale) predicts transition to daily smoking among individuals who do not smoke, and whether baseline daily smoking predicts the development of pain among those with no/low pain (scored 0-3). The pain and smoking outcomes were only included in the survival analysis if they persisted consistently throughout all subsequent years after the initial onset. Our analysis incorporated survey population controlled for alternative tobacco product use, gender, age categories, and race/ethnicity.

Results: Among the 32,320 participants, 49.5 % were women, the largest age cohort was 18-24 (28.2 %). Racial and ethnic distribution was 73.9 % White, 15.6 % Black, and 17.2 % Hispanic. Survival analysis revealed that baseline pain (scored ≥4) significantly increased the risk of transitioning to daily smoking (HR=2.40, 95 % CI=1.62-3.55, p < 0.001, n = 5731). Further, daily smoking at baseline was associated with an increased risk of developing persistent pain (scored ≥4) over the study period (HR=2.00, 95 % CI=1.86-2.16, p < 0.001, n = 12,099).

Conclusion: This study provides evidence for the existence of a bidirectional relationship between chronic pain and cigarette smoking. Treatment strategies should consider this relationship early, aiming to prevent development of persistent pain at its earliest stages.