Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain

Lori A Bastian, Mary Driscoll, Eric DeRycke, Sara Edmond, Kristin Mattocks, Joe Goulet, Robert D Kerns, Mark Lawless, Caroline Quon, Kim Selander, Jennifer Snow, Jose Casares, Megan Lee, Cynthia Brandt, Joseph Ditre, William Becker, Lori A Bastian, Mary Driscoll, Eric DeRycke, Sara Edmond, Kristin Mattocks, Joe Goulet, Robert D Kerns, Mark Lawless, Caroline Quon, Kim Selander, Jennifer Snow, Jose Casares, Megan Lee, Cynthia Brandt, Joseph Ditre, William Becker

Abstract

Introduction: Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective.

Methods: The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation.

Results: The 371 participants are 88% male, a median age of 60 years old (range 24-82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as "Fair" (40%) to "Poor" (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)).

Conclusions: PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.

Keywords: Cognitive behavioral treatment; Pain; Proactive recruitment; Smoking cessation; Tobacco.

Figures

Fig. 1
Fig. 1
CONSORT diagram for pain and smoking study.

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