Using Very Low Nicotine Content Cigarettes as a Strategy to Disrupt the Pain-Smoking Reinforcement Cycle

使用尼古丁含量极低的香烟作为扰乱吸烟强化循环的策略

• 批准号: 10458026
• 负责人: Maggie M Sweitzer
• 金额: $ 20.13万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10458026
• 关键词: Abstinence; Acute Pain; Aftercare; Analgesics; Attenuated; Back Pain; Behavior; Behavioral; Biological Markers; Chronic; Cigarette; Cognition; Complex; Coping Skills; Dependence; Development; Ecological momentary assessment; Extinction (Psychology); Feedback; Frequencies; General Population; Goals; Health; Health Care Costs; Hour; Hyperalgesia; Individual; Intention; Intervention; Laboratory Finding; Laboratory Study; Learning; Measures; Motivation; Negative Reinforcements; Nicotine; Nicotine Dependence; Nicotine Withdrawal; Pain; Pain intensity; Pain interference; Participant; Persons; Population; Price; Procedures; Productivity; Psychological reinforcement; Randomized; Reporting; Research; Risk; Risk Factors; Role; Self Efficacy; Severities; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Testing; Time; Tobacco smoking behavior; Tobacco use; Visit; Vulnerable Populations; Withdrawal; Withdrawal Symptom; Work; chronic back pain; chronic pain; chronic pain management; chronic painful condition; cigarette smoke; cigarette smoking; comorbidity; coping; craving; design; epidemiology study; expectation; improved; insight; interest; low nicotine content cigarette; negative affect; pain behavior; pain outcome; pain perception; pain relief; pain symptom; reduce symptoms; smoking abstinence; smoking cessation; tool

Tobacco smoking and chronic pain are highly comorbid conditions. Smoking and pain have been proposed to influence each other through a reciprocal positive feedback loop, in which pain increases motivation to smoke and smoking worsens pain over time. Nicotine has been shown to provide mild, short-term anti-nociceptive effects, which may contribute to powerful negative reinforcement learning. Conversely, smoking withdrawal exacerbates pain, presenting a potential barrier to smoking cessation. The goal of the proposed research is to examine whether switching to Very Low Nicotine Content (VLNC) cigarettes can directly weaken the pain-smoking reinforcement cycle, and attenuate withdrawal-induced hyperalgesia, among smokers with chronic pain. The research will employ a randomized between-subjects design to evaluate the effects of smoking VLNC’s versus Normal Nicotine Content (NNC) cigarettes on smoking behavior, pain, withdrawal symptoms and motivation to quit among daily smokers with chronic (>3 months) non-cancer back pain. Moreover, ecological momentary assessments (EMA) will be used to examine changes in bidirectional associations between pain, smoking urge and behavior as a function of cigarette condition. Participants will complete 1-week of baseline EMA while smoking their usual brand of cigarettes to familiarize them with study procedures; they will then be randomized to 4-weeks of NNCs or VLNCs. EMA will continue during weeks 1 and 4 of study cigarette use, and will assess smoking behavior and urge, negative affect, and pain intensity and interference. Participants will attend weekly in-person visits to obtain biomarker verification of cigarette compliance, and will complete measures of nicotine dependence, self-efficacy and motivation to quit, and pain-related coping. At the start of the study and at the end of 4-weeks of study cigarette use, a 24-hr smoking abstinence test will be used to assess withdrawal symptoms and withdrawal-induced hyperalgesia. In general, we hypothesize that switching to VLNCs will attenuate the bidirectional associations between smoking and pain as assessed via EMA, and will lead to decreased symptoms of withdrawal and pain during the 24-hour abstinence test. We also hypothesize that VLNCs will be associated with improvements in abstinence self-efficacy and intention to quit smoking, and decreased reliance on smoking to cope with pain. These results will provide critical insights into the role of nicotine in maintaining smoking/pain associations and the potential for VLNCs to extinguish learned associations to promote smoking cessation in this vulnerable population.

吸烟和慢性疼痛是高度共病的条件。吸烟和疼痛 有人提出，通过相互的正反馈回路相互影响，其中 疼痛增加了吸烟的动机，随着时间的推移，吸烟会减轻疼痛。尼古丁一直 显示提供温和的，短期的抗伤害作用，这可能有助于强大的 负强化学习相反，戒烟会加剧疼痛， 戒烟的潜在障碍。这项研究的目的是检查 转换到极低尼古丁含量（VLNC）香烟是否会直接削弱 疼痛-吸烟强化循环，并减弱戒断诱导的痛觉过敏， 慢性疼痛的吸烟者该研究将采用随机受试者间设计， 评价吸烟VLNC与正常尼古丁含量（NNC）香烟对 每日吸烟者的吸烟行为、疼痛、戒断症状和戒烟动机 慢性（>3个月）非癌症背痛。此外，生态瞬时评估 (EMA)将被用来检查疼痛，吸烟， 欲望和行为作为香烟状况的函数。参与者将完成为期一周的 基线EMA，同时吸烟他们常用的香烟品牌，以使他们熟悉研究 然后将他们随机分配至为期4周的NNC或VLNC。EMA将继续 在研究香烟使用的第1周和第4周期间，并将评估吸烟行为和冲动， 负面情绪、疼痛强度和干扰。参与者将每周亲自参加 访问以获得香烟依从性的生物标志物验证，并将完成 尼古丁依赖、自我效能和戒烟动机以及疼痛相关应对。开始时 在研究结束时，在4周的研究香烟使用结束时，24小时戒烟试验将 用于评估戒断症状和戒断引起的痛觉过敏。一般我们 假设切换到VLNC将减弱 通过EMA评估吸烟和疼痛，并将导致戒断症状减少 和疼痛的症状我们还假设VLNC将 与禁欲自我效能和戒烟意图的改善相关， 减少对吸烟的依赖以科普疼痛。这些结果将提供关键的见解， 尼古丁在维持吸烟/疼痛相关性中的作用以及VLNC 消除学会协会，以促进这一弱势群体戒烟。