title: Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients.
abstract: OBJECTIVE
  As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM-) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes.
  
  
  METHODS
  Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia.
  
  
  RESULTS
  Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM- patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM- smokers, and FM- nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference.
  
  
  CONCLUSIONS
  Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge.
authors: Department of Anesthesiology, University of Michigan, Ann Arbor MI, University of Michigan, Back & Pain Center, Burlington Building 1, Suite 310, 325 E. Eisenhower Parkway, Ann Arbor, Michigan, USA.
authors: Jenna
authors: J
authors: Goesling
authors: Department of Anesthesiology, University of Michigan, Ann Arbor MI, University of Michigan, Back & Pain Center, Burlington Building 1, Suite 310, 325 E. Eisenhower Parkway, Ann Arbor, Michigan, USA.
authors: Chad M
authors: CM
authors: Brummett
authors: Medical School, University of Michigan, Ann Arbor, MI.
authors: Taha S
authors: TS
authors: Meraj
authors: Department of Anesthesiology, University of Michigan, Ann Arbor MI, University of Michigan, Back & Pain Center, Burlington Building 1, Suite 310, 325 E. Eisenhower Parkway, Ann Arbor, Michigan, USA.
authors: Stephanie E
authors: SE
authors: Moser
authors: Department of Anesthesiology, University of Michigan, Ann Arbor MI, University of Michigan, Back & Pain Center, Burlington Building 1, Suite 310, 325 E. Eisenhower Parkway, Ann Arbor, Michigan, USA.
authors: Afton L
authors: AL
authors: Hassett
authors: Department of Psychology, Syracuse University, Syracuse, New York, USA.
authors: Joseph W
authors: JW
authors: Ditre
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000523:psychology*; D005260:Female; D005356:Fibromyalgia / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D012907:Smoking / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Chronic Pain; Depression; Fibromyalgia; Tobacco Smoking