title: The Perception of Female Smokers with Fibromyalgia on the Effects of Smoking on Fibromyalgia Symptoms.
abstract: OBJECTIVE
  Smokers with fibromyalgia have greater pain intensity and function impairment compared to nonsmokers. Patients' perceptions of interactions between smoking and fibromyalgia symptoms have not been described. The primary aim of this study was to report the perceptions of female smokers with fibromyalgia on how smoking affects symptoms.
  
  
  METHODS
  Forty-eight daily smokers with fibromyalgia enrolled in the Mayo Clinic Fibromyalgia Treatment Center completed the Fibromyalgia Impact Questionnaire, Fagerstrom Test for Nicotine Dependence, Patient Health Questionnaire-9, General Anxiety Disorder-7 and a Fibromyalgia Symptoms and Smoking Survey which queried how smoking directly affected fibromyalgia symptoms (eg, pain, tiredness/fatigue, stiffness, nervousness/anxiety, depression/blueness, irritability, concentration, and overall) or indirectly as a coping mechanism.
  
  
  RESULTS
  The majority of subjects reported smoking had no direct effect on fibromyalgia physical symptoms (pain [60% reported no effect], fatigue [56%], stiffness [81%]) but direct improvement of emotional symptoms (anxiety [62% reported improvement], irritability [64%]). The majority of subjects used smoking to cope with pain (69%) via distraction (83%) and relaxation (77%), lessening emotional distress by reducing a sense of frustration (83%) or sadness (54%) because of pain, and as a justification for resting vis-à-vis "smoke breaks" (69%). Thirty-one smokers were mildly and 17 moderately/severely dependent on tobacco, and no difference in fibromyalgia impact score (P = 0.70), pain (P = 0.39), depression (P = 0.20), and anxiety (P = 0.64) scores were detected, but more moderately/severely dependent subjects reported smoking improved pain (50% vs. 17%, P = 0.04).
  
  
  CONCLUSIONS
  Smokers with fibromyalgia reported smoking helped to cope with fibromyalgia pain but generally did not directly ameliorate fibromyalgia physical symptoms.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Ann
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Pain Rehabilitation Center, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Connie A
authors.initials: CA
authors.lastname: Luedtke
authors.affiliation: Health Services Research, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Beebe
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Tasha L
authors.initials: TL
authors.lastname: Welch
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Elisa Y
authors.initials: EY
authors.lastname: Chong
authors.affiliation: Health Services Research, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
keywords: chronic pain; coping strategies; fibromyalgia; perception; tobacco use