Low Nicotine Cigarettes, Smoking, and Chronic Pain (VLNCPain)

Using Very Low Nicotine Cigarettes to Disrupt the Pain-smoking Reinforcement Cycle

The purpose of this study is to evaluate the effects of switching to very low nicotine content (VLNC) cigarettes versus normal nicotine content (NNC) cigarettes on experiences with craving, withdrawal, and pain among individuals with chronic back pain who smoke cigarettes daily.

Study Overview

• Status: Completed
• Conditions: Chronic Pain; Smoking, Cigarette
• Intervention / Treatment: Other: SPECTRUM NRC 102/103 investigational cigarettes; Other: SPECTRUM NRC 600/601 investigational cigarettes

Detailed Description

The goal of this study is to evaluate the effects of very low nicotine content (VLNC) cigarettes on the dynamic associations between smoking, pain, and withdrawal among daily smokers with chronic (> 3 months) non-cancer back pain (n=48). Participants will complete an initial screening session to determine eligibility, followed by a baseline abstinence session in which measures of pain and withdrawal will be assessed following 24 hrs abstinence from smoking. At the conclusion of this session participants will receive training in ecological momentary assessment (EMA) procedures and software will be installed on their smartphone. Participants will then complete a 1-week baseline period, in which they will complete EMA while continuing to smoke usual brand cigarettes. During EMA, participants will receive 6 randomly spaced daily prompts, with 15 questions to complete about smoking behavior, mood, and current pain. In addition, participants will be asked to use their smartphone to indicate whenever they are about to smoke a cigarette. Three of these cigarettes each day will be randomly selected for assessment: in these cases participants will be asked to respond to the same 15 question before and after smoking the cigarette. Participants will also complete end of day questionnaires.

After the 1 week baseline period, participants will be randomly assigned to four weeks of either VLNCs (n=24) or normal nicotine content (NNC) cigarettes (n=24). During this period, participants will be asked to smoke only study cigarettes. Participants will attend weekly laboratory visits to provide biochemical verification of cigarette adherence (urine samples) and complete questionnaires. Study cigarettes will also be provided and collected at these visits. Two of the four weekly urine samples will be selected for analysis. Participants will also complete EMA during weeks 1 and 4 of study cigarette use. End of day questionnaires will continue throughout the 4 weeks.

At the conclusion of the study, participants will attend a final laboratory visit after abstaining from smoking for 24 hours. During this session, self-report measures of pain, craving, and withdrawal will be assessed, along with biochemical verification (breath sample) of abstinence.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• diagnosis of non-cancer chronic (>3 months) back pain (confirmed in medical record or by current provider);
• Pain duration of >=3 months with an average intensity of >/= 4/10 or worst pain >/=6/10 as assessed by Graded Chronic Pain Scale (GCPS);
• smoking at least 10 cigarettes per day for > 2 years;
• expired breath CO concentration > 10 ppm;
• have an iPhone or Android smartphone capable of running EMA software

Exclusion Criteria:

• actively taking steps to quit smoking;
• inability to attend all required experimental sessions;
• report of significant health problems;
• systolic blood pressure > 160 or diastolic blood pressure > 100;
• resting heart rate > 100;
• breath alcohol level > 0.0;
• current use of opioid pain relievers;
• lifetime history of bipolar or psychotic disorder;
• current unstable psychiatric disorder as assessed by the MINI;
• use of non-cigarette tobacco products > 8 times in the past 30 days;
• current use of nicotine replacement therapy (NRT) or other smoking cessation strategy;
• use of Spectrum investigational cigarettes in the past year;
• quit attempt in the past 30 days resulting in > 3 days abstinence;
• past year alcohol or substance use disorder;
• use of illegal drugs as measured by urine drug screen;
• pain complaint due to specific medical conditions (e.g., cancer, rheumatoid arthritis, complex regional pain syndrome);
• spine surgery within the past year or planned surgery within the timeframe of the study;
• current disability litigation pending;
• positive pregnancy test among women

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: VLNC Group; Participants in this condition will be provided with Spectrum NRC102/103 (nonmenthol/menthol) cigarettes, which have a nicotine content of approximately 0.4 mg/g tobacco with reported nicotine yield (ISO) of 0.03 +/- 0.01 mg and a tar yield of 9 +/- 1.5. Participants will be asked to smoke only study cigarettes for 4 weeks.	Other: SPECTRUM NRC 102/103 investigational cigarettes; Very low nicotine content (nonmenthol/menthol) SPECTRUM investigational cigarettes
Active Comparator: NNC Group; Participants in this condition will be provided with Spectrum NRC600/601 (non-menthol/menthol) cigarettes, which have a nicotine content of approximately 15.8 mg/g tobacco with reported nicotine yield (ISO) of 0.8 +/- 0.15 mg and a tar yield of 10.5 +/- 1.5.	Other: SPECTRUM NRC 600/601 investigational cigarettes; Normal nicotine content (nonmenthol/menthol) SPECTRUM investigational cigarettes

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cigarettes Smoked Per Day	Average number of cigarettes smoked per day over the past week, as reported on timeline follow-back interview at each weekly visit	Weekly for 5 weeks
Weekly Measures of Cigarette Dependence as Assessed by the Fagerstrom Test of Cigarette Dependence (FTCD)	The FTCD is a widely used 6-item measure of dependence, with total scores ranging from 0 (low dependence) to 10 (high dependence)	Weekly for 5 weeks
Weekly Ratings of Withdrawal Symptoms as Measured by the Minnesota Tobacco Withdrawal Scale	The MNWS is a 7-item measure of withdrawal symptoms, with responses indicated on a likert scale ranging from 0 (none) to 4 (severe). The total score ranges from 0 to 28, with higher scores indicating greater withdrawal symptoms.	Weekly for 5 visits
Weekly Changes in Pain Intensity as Measured by the Past-week Version of the Brief Pain Inventory (BPI)	The BPI is a well-validated 11-item self-report measure. Pain intensity is calculated as the average of 3 items (worst pain, least pain, and average pain). Scores are averaged with the total score ranging from 0 to 10 with higher scores indicating more pain.	Weekly for 5 visits
Ratings of Withdrawal Symptoms During Smoking Abstinence, as Measured by the Minnesota Tobacco Withdrawal Scale (MNWS)	The MNWS is a 7-item measure of withdrawal symptoms, with responses indicated on a likert scale ranging from 0 (none) to 4 (severe). The total score ranges from 0 to 28, with higher scores indicating greater withdrawal symptoms.	Baseline (pre-intervention) abstinence session (i.e., prior to week 1), follow-up abstinence session (immediately after final week of cigarette use; i.e., week 5)
Pain Intensity During Smoking Abstinence as Measured by the Past 24-hour Version of the Brief Pain Inventory (BPI)	The BPI is a well-validated 11-item self-report measure. Pain intensity is calculated as the average of 3 items (worst pain, least pain, and average pain). Scores are averaged with the total score ranging from 0 to 10 with higher scores indicating more pain.	Baseline (pre-intervention) abstinence session (i.e., before week 1), follow-up abstinence session (immediately after final week of cigarette use; i.e., week 5)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in smoking abstinence self-efficacy as measured by the Smoking Self-Efficacy Questionnaire (SEQ-12)	The SEQ-12 is a 12-item measure yielding scores for self-efficacy when faced with both external (situational) or internal (e.g., affective) stimuli, with higher scores indicating greater confidence in abstaining from smoking	Weekly visits 1 and 5
Changes in motivation to quit smoking as measured by the Contemplation Ladder	The contemplation ladder is a single-item measure of a person's current thoughts about quitting smoking, ranging from 0 (I have no thought of quitting) to 10 (I am doing something to try to quit)	Weekly visits 1 and 5
Changes in smoking to cope with pain as measured by the Pain and Smoking Inventory (PSI)	The PSI is a 9-item measure of pain as a motivator to smoke, smoking to cope with pain, and pain as a barrier to smoking cessation, with responses indicated on a 7-point likert scale ranging from 0 (not true at all) to 6 (extremely true)	Weekly visits 1 and 5

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in Smoking to Cope With Pain as Measured by the Pain and Smoking Inventory (PSI)	The PSI is a 9-item measure of pain as a motivator to smoke, smoking to cope with pain, and pain as a barrier to smoking cessation, with responses indicated on a 7-point likert scale ranging from 0 (not true at all) to 6 (extremely true). Scores are averaged and the total score ranges from 0-6, with higher scores indicating that pain is a greater motivator to smoke.	Weekly visits 1, 3, and 5
Changes in Motivation to Quit Smoking as Measured by the Contemplation Ladder	The contemplation ladder is a single-item measure of a person's current thoughts about quitting smoking, ranging from 0 (I have no thought of quitting) to 10 (I am doing something to try to quit)	Weekly visits 1, 3, and 5
Changes in Smoking Abstinence Self-efficacy as Measured by the Smoking Self-Efficacy Questionnaire (SEQ-12)	The SEQ-12 is a 12-item measure yielding scores for self-efficacy when faced with both external (situational) or internal (e.g., affective) stimuli. Responses on each item range from 1 to 5, with higher scores indicating greater confidence in abstaining from smoking. Total score ranges from 12 to 60.	Weekly visits 1, 3, and 5
Pain Intensity Ratings During Ecological Momentary Assessment	Responses to the question "Right now, how intense is your pain?", rated on a 1 (not at all) to 9 (extremely) likert scale at multiple timepoints throughout the day over the course of a week. All responses recorded within a week (up to 35 per participant) were averaged to create a single value ranging from 1 to 9, with higher scores indicating more pain.	Baseline (pre-randomization; i.e., week 1) and the first and last weeks of study cigarette use (i.e., weeks 2 and 5)
Smoking Urge Ratings During Ecological Momentary Assessment	Responses to question "How strong is your current urge to smoke?", rated on a 1 (not strong at all) to 9 (extremely strong) likert scale, assessed at multiple timepoints each day. All responses recorded within a week (up to 35 per participant) were averaged to create a single value ranging from 1 to 9, with higher scores indicating greater smoking urge.	Baseline (pre-randomization; i.e., week 1) and the first and last weeks of study cigarette use (i.e., weeks 2 and 5)
Negative Affect Ratings During Ecological Momentary Assessment	Average of responses to 4 negative affect items (anxious, irritable, guilty sad) using the question prompt, "Right now, how much are you feeling...?", rated on a 1 (not at all) to 9 (extremely) likert scale, assessed at multiple times per day. All responses recorded within a week (up to 35 per participant) were averaged to create a single value ranging from 1 to 9, with higher scores indicating greater negative affect.	Baseline (pre-randomization; i.e., week 1), and the first and last weeks of study cigarette use (i.e., weeks 2 and 5)
Intent to Smoke During Ecological Momentary Assessment	Proportion of "yes" responses to question "Are you about to smoke a cigarette right now?", assessed multiple times during the day. Total "yes" responses were divided by total observations within each week to calculate proportion of responses.	Baseline (pre-randomization; i.e., week 1) and the first and last weeks of study cigarette use (i.e., weeks 2 and 5)

Collaborators and Investigators

• Sponsor: Duke University
• Collaborators: National Institute on Drug Abuse (NIDA)
• Investigators: Principal Investigator: Maggie Sweitzer, Duke University

Study record dates

Study Major Dates

• Study Start (Actual): June 23, 2022
• Primary Completion (Actual): July 4, 2024
• Study Completion (Actual): July 4, 2024

Study Registration Dates

• First Submitted: August 27, 2021
• First Submitted That Met QC Criteria: September 1, 2021
• First Posted (Actual): September 2, 2021

Study Record Updates

• Last Update Posted (Estimated): August 29, 2025
• Last Update Submitted That Met QC Criteria: August 15, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Smoking; Tobacco Smoking; Tobacco Use; Chronic Pain; Cigarette Smoking
• Other Study ID Numbers: Pro00108705; R21DA052729 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No