The effects of smoking status on opioid tapering among patients with chronic pain

The primary aim of this study was to determine if smoking status affected the ability of patients with chronic pain to reduce opioid consumption during a 3-wk pain rehabilitation program. Secondary aims included determining the associations between smoking status, admission opioid use, and pain severity.

We used a retrospective, repeated measures design to assess pre- and post-treatment outcomes in a consecutive series of patients admitted to a 3-wk, outpatient pain treatment program from September 2003 through February 2007. Outcome measures included the frequency of successful opioid tapering, pain severity subscale of the Multidisciplinary Pain Inventory, and program completion status.

The study cohort included 1241 patients (women 928); 313 (25%) smokers, 294 (24%) former smokers, and 634 (51%) never smokers. There were more smokers using opioids at admission (P < 0.001) compared to former and never smokers. Likewise, the mean morphine equivalent dose (P = 0.013) and pain severity scores (P < 0.001) of smokers were higher compared to former and never smokers. The success of opioid tapering did not depend on smoking status, and all groups experienced significant reductions in pain severity at program completion (P < 0.001). However, a higher proportion of smokers did not complete treatment (P < 0.001).

For patients completing a pain rehabilitation program, most were able to eliminate opioid use, regardless of smoking status. However, significantly more smokers did not complete treatment. The most frequent reasons for program noncompletion included discrepant expectations of treatment, acute illness, and psychosocial stressors.