Smoking Cessation Among Patients with Chronic Pain in a Comparative Effectiveness Trial

BACKGROUND: Many patients with chronic pain smoke cigarettes; they report lacking skills to cope with pain, a smoking trigger. OBJECTIVE: Test the effectiveness of a telephone-delivered, cognitive-behavioral intervention (CBI) incorporating pain self-management to promote smoking cessation among people with chronic pain compared to a smoking cessation counseling control (Standard). DESIGN: Randomized trial. PARTICIPANTS: Current cigarette smoking, willingness to make a quit attempt, pain for ≥ 3 months with worst past week pain intensity of ≥ 4 on the 0-10 pain numerical rating scale. INTERVENTIONS: CBI included 5 telephone sessions integrating smoking cessation and pain self-management, and combination nicotine replacement therapy (NRT). Standard included 5 telephone sessions and NRT. MAIN MEASURES: Primary outcome used for power analysis was 14-day prolonged abstinence at 6 months. Other smoking outcomes included 7-day and 30-day point prevalence abstinence and 7-day prolonged abstinence at 6 and 12 months and 14-day prolonged abstinence at 12 months. Secondary outcomes included change in pain intensity and interference at 6 and 12 months. KEY RESULTS: Patients were randomly assigned to CBI (n = 189) and Standard (n = 182), stratified by sex. Patients (88% men, median age = 60 years) smoked a median of 15 cigarettes per day with moderate pain intensity (5.2 (SD = 1.6)) and pain interference (5.5 (SD = 2.2)). Participation in all 5 counseling calls was higher in CBI (38% vs. 29%), and there was no difference in NRT use (47% vs. 45%). There were no differences by arm in smoking or pain outcomes. CONCLUSIONS: Our study did not detect a difference in smoking cessation between standard counseling and counseling with enhanced content around pain self-management. TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT02971137 Registered 2016-11-16.