Smoking Status and Pain Intensity Among OEF/OIF/OND Veterans.
OBJECTIVE
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).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Bryant University, Smithfield, Rhode Island.
Julie E
JE
Volkman
VA Connecticut Healthcare System, West Haven, Connecticut.
Eric C
EC
DeRycke
VA Connecticut Healthcare System, West Haven, Connecticut.
Mary A
MA
Driscoll
VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
William C
WC
Becker
VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
Cynthia A
CA
Brandt
VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts.|University of Massachusetts Medical School, Worcester, Massachusetts.
Kristin M
KM
Mattocks
VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
Sally G
SG
Haskell
VA Connecticut Healthcare System, West Haven, Connecticut.
Harini
H
Bathulapalli
VA Connecticut Healthcare System, West Haven, Connecticut.|Yale University School of Medicine, New Haven, Connecticut.
Joseph L
JL
Goulet
VA Connecticut Healthcare System, West Haven, Connecticut.|University of Connecticut Health Center, Farmington, Connecticut.
Lori A
LA
Bastian
D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010146:Pain / Q000453:epidemiology*; D010147:Pain Measurement; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D014728:Veterans
Pain; Smoking; Tobacco; Veterans