Volkman Julie E, DeRycke Eric C, Driscoll Mary A, Becker William C, Brandt Cynthia A, Mattocks Kristin M, Haskell Sally G, Bathulapalli Harini, Goulet Joseph L, Bastian Lori A
Bryant University, Smithfield, Rhode Island.
VA Connecticut Healthcare System, West Haven, Connecticut.
Pain Med. 2015 Sep;16(9):1690-6. doi: 10.1111/pme.12753. Epub 2015 Apr 27.
Pain and smoking are highly prevalent among Veterans. Studies in non-Veteran populations have reported higher pain intensity among current smokers compared with nonsmokers and former smokers. We examined the association of smoking status with reported pain intensity among Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND).
The sample consisted of OEF/OIF/OND Veterans who had at least one visit to Veterans Affairs (2001-2012) with information in the electronic medical record for concurrent smoking status and pain intensity. The primary outcome measure was current pain intensity, categorized as none to mild (0-3); moderate (4-6); or severe (≥7); based on a self-reported 11-point pain numerical rating scale. Multivariable logistic regression analyses were used to assess the association of current smoking status with moderate to severe (≥4) pain intensity, controlling for potential confounders.
Overall, 50,988 women and 355,966 men Veterans were examined. The sample mean age was 30 years; 66.3% reported none to mild pain; 19.8% moderate pain; and 13.9% severe pain; 37% were current smokers and 16% former smokers. Results indicated that current smoking [odds ratio (OR) = 1.29 (95% confidence intervals (CI) = 1.27-1.31)] and former smoking [OR = 1.02 (95% CI = 1.01-1.05)] were associated with moderate to severe pain intensity, controlling for age, service-connected disability, gender, obesity, substance abuse, mood disorders, and Post Traumatic Stress Disorder.
We found an association between current smoking and pain intensity. This effect was attenuated in former smokers. Our study highlights the importance of understanding reported pain intensity in OEF/OIF/OND Veterans who continue to smoke.
疼痛和吸烟在退伍军人中极为普遍。针对非退伍军人人群的研究报告称，与不吸烟者和既往吸烟者相比，当前吸烟者的疼痛强度更高。我们研究了持久自由行动、伊拉克自由行动和新黎明行动（OEF/OIF/OND）退伍军人的吸烟状况与报告的疼痛强度之间的关联。
样本包括在2001年至2012年期间至少一次前往退伍军人事务部就诊的OEF/OIF/OND退伍军人，其电子病历中包含同期吸烟状况和疼痛强度信息。主要结局指标为当前疼痛强度，根据自我报告的11点疼痛数字评分量表分为无至轻度（0 - 3）、中度（4 - 6）或重度（≥7）。多变量逻辑回归分析用于评估当前吸烟状况与中度至重度（≥4）疼痛强度之间的关联，并对潜在混杂因素进行控制。
总体而言，共检查了50988名女性退伍军人和355966名男性退伍军人。样本的平均年龄为30岁；66.3%报告无至轻度疼痛；19.8%报告中度疼痛；13.9%报告重度疼痛；37%为当前吸烟者，16%为既往吸烟者。结果表明，在控制年龄、与服役相关的残疾、性别、肥胖、药物滥用、情绪障碍和创伤后应激障碍后，当前吸烟[比值比（OR）= 1.29（95%置信区间（CI）= 1.27 - 1.31）]和既往吸烟[OR = 1.02（95% CI = 1.01 - 1.05）]与中度至重度疼痛强度相关。
我们发现当前吸烟与疼痛强度之间存在关联。这种影响在既往吸烟者中有所减弱。我们的研究强调了了解继续吸烟的OEF/OIF/OND退伍军人报告的疼痛强度的重要性。
