Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Lynne Jensen

Clinical Mentor

Dr. Chizimuzo T. C. Okoli

Committee Member

Dr. Judi Daniels


Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and intensity of pain, can contribute to a higher dose of opioid therapy. Hence, it is critical to understand smoking behaviors and opioid use in managing pain among those with chronic pain.

Purpose: The purpose of this project was to examine the relationship between smoking and opioid use in managing pain among patients at a chronic pain management clinic.

Methods: This project was a single-center, retrospective chart review to evaluate the relationship between smoking, chronic pain, and the use of opioids. The project was conducted over a six-month time frame (from June 1, 2017- November 30, 2017) and the sample consisted of 37 subjects: 7 smokers and 30 non-smokers. Information on smoking history, opioid medication use, and perceived pain using the Global Pain Scale (GPS) was obtained from attendants at a pain clinic. A two-sample t-test was used to compare differences in average pain scores and morphine milligram equivalent (MME) for opioid use between smokers and non-smokers.

Results: The average pain rating for the entire project population (n=37) was six, with an average GPS score of 31. The average acceptable pain level was five. When the data was analyzed separately, smokers were found to have an average GPS score of 30 and an average pain rating of 6.7/10, while non-smokers were found to have an average GPS of 21 and an average pain score of 6/10; but these differences were not statistically significant. The MME was higher for smokers than for non-smokers (26.4mg MME vs. 21.9mg MME), but these differences were not statistically significant.

Conclusion: Patients with chronic pain who smoke have a higher pain rating compared to non-smokers, therefore, possibly requiring higher use of opioids. Providers are encouraged to use evidence-based smoking cessation treatment to assist their patients who smoke. To improve overall patient health, patient experience, and quality of life, providers should screen, advise, and counsel patients with chronic pain to abstain from smoking, which may ultimately result in decreased opioid need and use.