Pain, smoking, and moderating effect of gender in a large, representative sample of Danish adults

Comorbidity between smoking and chronic pain is well-documented, but gender differences in the pain-smoking relationship are not well understood. Although men experience greater acute analgesic benefit from smoking, pain may be more highly related to nicotine dependence and barriers to quitting among women. Utilizing a large, representative sample of adults in Denmark (N = 18,019), the current study examined gender as a moderator of the relationship between pain and smoking. Being a current smoker was related to greater likelihood of experiencing pain in univariate analysis (Chi-Square = 67.07, p < .01). In the multivariate logistic regression analysis, being male (log odds = .28, p < .01), having pain (log odds = .37, p < .01), and having lower education level (log odds = -.37, p < .01) increased the likelihood of being a current smoker. The negative Gender X Pain interaction was also significant (log odds = -.17, p = .02), indicating that among males, the effect (in log odds) of Pain on Smoking was lower, when compared to females. The stronger relationship between pain and smoking observed among women may indicate that women are more likely to use smoking means of coping with pain than men. It is also possible that over the long-term, smoking exacerbates painful conditions to a higher degree among women than men. Future research should seek to clarify differences in smoking negative reinforcement expectancies, nicotine dependence, and barriers to quitting between male and female smokers with pain.