Encinosa William, Bernard Didem, Valdez R Burciaga
Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, United States; McCourt School of Public Policy, Georgetown University, Washington, DC, United States.
Division of Research and Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, United States.
J Pain. 2025 Jan;26:104707. doi: 10.1016/j.jpain.2024.104707. Epub 2024 Oct 13.
It is known that smoking is associated with greater chronic pain. However, little is known about the magnitude of this relationship and its association with prescription opioid use. We examine the association between smoking status and three sets of outcomes: (1) starting and discontinuing opioids, (2) intensity of opioid use, and (3) opioid use and pain outcomes after quitting smoking. We use multinomial logit on adults in the nationally representative 2013-2021 Medical Expenditure Panel Survey linked to the National Health Interview Survey (N = 36,796). Smoking adults made up 16% of the population but used 30% of all opioid prescriptions and 40% of all annual Morphine Milligram Equivalents (MMEs). The 1% of the population that smoked and had severe work limitations due to pain used 20% of all MMEs. Smoking adults were 24% more likely than never-smoking adults to have chronic pain. Among those with pain, smoking adults had 46% higher relative risk of starting opioids compared to never-smoking adults (p < .01), and smoking adults had 6.6 times higher relative risk of continuing opioids the next year compared to never-smoking adults (p < .01). Those smoking and using opioids had 95% higher odds of using a prescribed dosage of 50 MME or more than never-smoking adults. A year after quitting smoking, opioid use declined by 20% and pain declined by 23% compared to those continuing to smoke, with no difference from never-smoking adults after 12 years. Integrating smoking cessation into pain management programs could be highly beneficial to adults with chronic pain. PERSPECTIVE: Rarely are smoking cessation and pain management programs integrated together. We show that such integration would be highly beneficial by estimating a strong association between smoking cessation and reduced chronic pain, work limitations, and prescription opioid use.
众所周知，吸烟与更严重的慢性疼痛有关。然而，对于这种关系的程度及其与处方阿片类药物使用的关联却知之甚少。我们研究了吸烟状况与三组结果之间的关联：（1）开始和停止使用阿片类药物，（2）阿片类药物使用强度，以及（3）戒烟后阿片类药物使用与疼痛结果。我们对2013 - 2021年全国代表性医疗支出面板调查中的成年人使用多项逻辑回归，该调查与国家健康访谈调查相关联（N = 36,796）。吸烟成年人占人口的16%，但使用了所有阿片类药物处方的30%以及所有年度吗啡毫克当量（MME）的40%。因疼痛而有严重工作限制的吸烟成年人占人口的1%，却使用了所有MME的20%。吸烟成年人患慢性疼痛的可能性比从不吸烟的成年人高24%。在有疼痛的人群中，吸烟成年人开始使用阿片类药物的相对风险比从不吸烟的成年人高46%（p < 0.01），并且吸烟成年人次年继续使用阿片类药物的相对风险比从不吸烟的成年人高6.6倍（p < 0.01）。与从不吸烟的成年人相比，吸烟且使用阿片类药物的人使用50 MME或更高规定剂量的几率高95%。戒烟一年后，与继续吸烟的人相比，阿片类药物使用量下降了20%，疼痛程度下降了23%，12年后与从不吸烟的成年人没有差异。将戒烟纳入疼痛管理项目可能对患有慢性疼痛的成年人非常有益。观点：戒烟和疼痛管理项目很少整合在一起。我们通过估计戒烟与减轻慢性疼痛、工作限制和处方阿片类药物使用之间的强关联表明，这种整合将非常有益。
