Pain as a Motivator of Smoking: Mechanisms of Action

描述（由申请人提供）：项目摘要。慢性疼痛每年影响超过5000万美国人，是美国身体损害的第三大原因，仅次于癌症和心脏病。烟草使用，特别是吸烟，每年造成的经济影响超过1670亿美元，几乎损害身体的每一个器官，仍然是美国主要的可预防死亡原因。慢性疼痛患者的吸烟率大约是一般人群的两倍。研究表明，吸烟可能是慢性疼痛状况发展和恶化的危险因素。然而，与吸烟相关镇痛的证据一致，大多数患者在疼痛时声称需要吸烟，并且已报告疼痛强度与吸烟数量之间呈正相关。此外，申请人最近的一项研究提供了第一个实验证据，证明情境疼痛是吸烟的一个有力动机。拟议的研究的主要目标是测试疼痛和吸烟动机之间的因果关系，通过操纵潜在的中介和调节变量，影响社会学习理论为基础的概念化的疼痛应对和成瘾动机。在该2X2交叉因子受试者间设计中，共132名吸烟者将被随机分配至4种条件之一。我们假设，在疼痛诱导后，与对照条件相比，旨在（1）增强疼痛相关应对行为和（2）减少吸烟相关结果预期的操作将分别降低吸烟动机。我们还将测试这两种操作之间的交互协同效应。第一个因素操纵一个变量，疼痛文献已显示预测疼痛反应性降低，而第二个因素操纵一个变量，已显示在吸烟文献中影响吸烟动机。因此，目前的建议借鉴了疼痛和吸烟文献。本案无关这个实验设计将使我们能够测试可能构成和影响疼痛和增强吸烟动机之间因果关系的理论机制。该设计还将作为变量的模拟测试，这些变量可能值得进一步调查其影响针对患有疼痛和成瘾障碍共病个体的干预措施发展的能力。这一系列研究的最终目标是更好地了解吸烟与慢性疼痛之间的关系，并针对慢性疼痛患者制定预防吸烟、戒烟和预防复发的干预措施。

DESCRIPTION (provided by applicant): Project Summary. Chronic pain affects more than 50 million Americans per year and is the third leading cause of physical impairment in the United States, following cancer and heart disease. Tobacco use, particularly cigarette smoking, has an economic impact of over $167 billion annually, harms nearly every organ of the body, and remains the leading preventable cause of death in the United States. The prevalence of smoking among chronic pain patients is approximately double that of the general population. Research suggests that smoking may be a risk factor for the development and exacerbation of chronically painful conditions. However, consistent with evidence of smoking-related analgesia, most patients declare a need to smoke when in pain, and positive correlations between pain intensity and number of cigarettes smoked have been reported. Furthermore, a recent study by the applicant provided the first experimental evidence that situational pain is a potent motivator of smoking. The main goal of the proposed study is to test the causal relationship between pain and smoking motivation by manipulating potential mediating and moderating variables, as influenced by social learning theory-based conceptualizations of pain coping and addiction motivation. A total of 132 smokers will be randomly assigned to one of four conditions in this 2X2 crossed factorial between-subjects design. We hypothesize that, following pain induction, manipulations designed to (1) enhance pain-related coping behaviors, and (2) diminish smoking-related outcome expectancies will each reduce motivation to smoke, when compared to control conditions. We will also test for an interactive, synergistic effect between the two manipulations. The first factor manipulates a variable that the pain literature has shown to predict reduced pain reactivity, whereas the second factor manipulates a variable that has been shown in the smoking literature to influence smoking motivation. Thus, the current proposal draws upon both the pain and smoking literature. Relevance. This experimental design will allow us to test theoretical mechanisms that may underlie and impact the causal relationship between pain and enhanced smoking motivation. This design will also serve as an analogue test of variables that may merit further investigation for their capacity to influence the development of interventions targeted at individuals with comorbid pain and addiction disorders. The ultimate goals of this line of research are to better understand the relationship between smoking and chronic pain, and to develop smoking prevention, cessation, and relapse prevention interventions targeted at individuals who endure chronic pain.