title: Ecological momentary assessment of smoking behavior in persistent pain patients.
abstract: OBJECTIVE
  Smoking is associated with chronic pain and pain-related functional impairment. Some studies suggest that pain activates smoking urges and others suggest that smoking is analgesic. We evaluated these associations using ecological momentary assessment, a method for real-time measurement of health-related phenomena.
  
  
  METHODS
  For 1 week, 36 chronic pain patients who smoked a mean of 17.5 (SD=9.4) cigarettes per day completed multiple daily assessments on a handheld computer.
  
  
  RESULTS
  The sample included 67% women and 39% whites; 67% had back pain, with an average (SD) worst pain severity during the past week of 8.6 (1.5) on a 0 to 10 numeric rating scale. Patients completed an average (SD) of 44 (24) random assessments. At each assessment, the patient recorded pain "right now" on a 0 to 10 scale, whether he/she was "about to smoke," and if he/she had "just smoked in the past 30 minutes," pain before smoking. After controlling for other significant correlates of pain, patients who were about to smoke had more pain than at other times (M [SD]=6.5 [2.3] vs. 5.2 [2.4]; P<0.01), but pain before and after smoking was not different (M [SD]=6.1 [2.2] vs. 5.9 [2.3]; P=0.18).
  
  
  CONCLUSIONS
  These findings support the hypothesis that smoking behavior is triggered by pain, but smoking is not analgesic. Future studies should clarify potential explanatory mechanisms for this pain-related trigger and evaluate tailored cessation strategies for pain patients.
authors.affiliation: *Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York Departments of †Neurology and Psychiatry and Behavioral Sciences §Medicine #Neurology and Anesthesiology, Albert Einstein College of Medicine ¶Albert Einstein College of Medicine of Yeshiva University, Bronx ‡Maimonides Medical Center, Brooklyn ∥The New School for Social Research, New York, NY.
authors.forename: Lara K
authors.initials: LK
authors.lastname: Dhingra
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: Bella
authors.initials: B
authors.lastname: Grossman
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.forename: Elyssa
authors.initials: E
authors.lastname: Scharaga
authors.forename: Steven
authors.initials: S
authors.lastname: Calamita
authors.forename: Jae
authors.initials: J
authors.lastname: Shin
authors.forename: Russell
authors.initials: R
authors.lastname: Portenoy
mesh_terms: D059350:Chronic Pain / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D010147:Pain Measurement; D057566:Self Report; D012907:Smoking; D012959:Socioeconomic Factors; D013997:Time Factors