Klinik Araştırma
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Kronik Ağrı Hastalarında Şiddetli Nikotin Bağımlılığının Öngördürücüleri

Yıl 2025, Cilt: 47 Sayı: 5, 816 - 827, 04.09.2025
https://doi.org/10.20515/otd.1637221

Öz

Kronik ağrı ve nikotin bağımlılığı birlikteliği, fiziksel ve ruhsal hastalıkların riskini arttırmaktadır. Bu nedenle kronik ağrı, sigara kullanımı ve nikotin bağımlılığı arasındaki ilişkinin anlaşılması, etkili müdahaleler geliştirmek için kritik öneme sahiptir. Bu çalışma, kronik ağrısı olan hastalarda şiddetli nikotin bağımlılığı riskinin öngördürücüleri olarak ağrı şiddeti, anksiyete ve depresyon semptomları, anksiyete duyarlılığı ve sıkıntıya dayanma düzeylerini ortaya koymayı amaçlamıştır. Çalışmaya, kronik ağrısı olan, ağrı yönetimi için tedavi gören ve sigara içen 76 kişi katılmıştır (ortalama yaş = 50.28 ± 12.37, %63.2 kadın). Çalışmada; ağrı şiddeti, anksiyete ve depresyon semptomları, anksiyete duyarlılığı ve sıkıntıya dayanma düzeyleri ile nikotin bağımlılığı riskini değerlendirmek için öz-bildirim ölçekleri kullanılmıştır. Şiddetli nikotin bağımlılığı riskinin belirleyicilerini saptamak amacıyla tek değişkenli lojistik regresyon analizi yapılmıştır. Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) kesme değerlerine göre, hastaların %34.2’si anksiyete (n=26) ve %56.6’sı depresyon (n=43) bildirmiştir. HADÖ’nün anksiyete alt ölçek puanları (odds oranı = 1.125 [1.016–1.245]), Anksiyete Duyarlılığı Ölçeği-3 toplam puanları (odds oranı = 1.038 [1.005–1.073]) ve ağrı şiddeti (odds oranı = 1.331[1.030–1.720]) şiddetli nikotin bağımlılığı riskini anlamlı şekilde öngörmüştür (sırasıyla p=0.023, p=0.025, p=0.029). Bu çalışma, kronik ağrı hastalarında sigara kullanımı ve ruh sağlığının ele alınmasının gerekliliğine dikkat çekmekte ve bu hasta grubunda sigara bırakma sürecinde potansiyel müdahale alanları olarak ağrı yönetimi, anksiyete semptomları ve anksiyete duyarlılığının önemini vurgulamaktadır.

Kaynakça

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  • 27. Redmond BY, Bizier A, Salwa A, Brown RA, Garey L, Zvolensky MJ. Transdiagnostic Risk Factors for Reasons for Smoking: Evaluating the Concurrent Role of Distress Tolerance and Anxiety Sensitivity. Int J Behav Med. 2024 Oct 31.
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  • 32. Aydemir Ö. Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turk Psikiyatri Derg. 1997;8:280-7.
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Predictors of Severe Nicotine Dependence in Patients with Chronic Pain

Yıl 2025, Cilt: 47 Sayı: 5, 816 - 827, 04.09.2025
https://doi.org/10.20515/otd.1637221

Öz

The combined presence of chronic pain and nicotine dependence has been shown to elevate the risk of both physical and mental illnesses. Consequently, understanding the interconnected relationship between chronic pain, smoking, and nicotine dependence is crucial for developing effective interventions and improving patient outcomes. The present study aimed to reveal if pain intensity, symptoms of anxiety and depression, anxiety sensitivity, and distress tolerance serve as predictive factors of severe nicotine dependence risk among patients with chronic pain. Seventy-six smokers with chronic pain were recruited (mean age = 50.28±12.37, 63.2% female). The study utilized self-reported measures to assess pain intensity, distress tolerance, anxiety sensitivity, nicotine dependence, and symptoms of anxiety and depression. Univariate binary logistic regression was performed to find the predictors of severe nicotine dependence risk. Among the patients, 34.2% reported anxiety (n=26), and 56.6% reported depression (n=43). The anxiety subscale scores of the HADS (odds ratio = 1.125 [1.016–1.245]) and the total scores of the ASI-3 (odds ratio = 1.038 [1.005–1.073]) significantly predicted severe nicotine dependence risk (p = 0.023 and p = 0.025, respectively), as well as pain intensity over the past week (odds ratio = 1.331[1.030–1.720]; p = 0.029). This study highlights the need to address smoking behavior and mental health in patients with chronic pain and emphasizes the importance of pain management, anxiety symptoms, and anxiety sensitivity as potential targets for intervention in smoking cessation efforts within this population.

Kaynakça

  • 1. Report on the Global Tobacco Epidemic, 2023: Protect People from Tobacco Smoke. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
  • 2. World Health Organization. Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco. Accessed: July 31, 2023.
  • 3. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.
  • 4. Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
  • 5. World Health Organization. Smoking is the Leading Cause of Chronic Obstructive Pulmonary Disease. https://www.who.int/news/item/15-11-2023-smoking-is-the-leading-cause-of-chronic-obstructive-pulmonary-disease.Accessed: November 15, 2023.
  • 6. Niv D, Devor M. Chronic pain as a disease in its own right. Pain Pract. 2004 Sep;4(3):179-81.
  • 7. Chen D, Shen L, Zhang YZ, Kan BF, Lou QQ, Long DD, Huang JY, Zhang Z, Hu SS, Wang D. Chronic nicotine exposure elicits pain hypersensitivity through activation of dopaminergic projections to anterior cingulate cortex. Br J Anaesth. 2024 Apr;132(4):735-745.
  • 8. Zvolensky MJ, McMillan KA, Gonzalez A, Asmundson GJ. Chronic musculoskeletal pain and cigarette smoking among a representative sample of Canadian adolescents and adults. Addict Behav. 2010 Nov;35(11):1008-12.
  • 9. Zale EL, Ditre JW, Dorfman ML, Heckman BW, Brandon TH. Smokers in pain report lower confidence and greater difficulty quitting. Nicotine Tob Res. 2014 Sep;16(9):1272-6.
  • 10. Khan JS, Hah JM, Mackey SC. Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain. 2019 Oct;160(10):2374-2379.
  • 11. United States Public Health Service Office of the Surgeon General and National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking Cessation: A Report of the Surgeon General. US Department of Health and Human Services, 2020.
  • 12. Zvolensky MJ, Rogers AH, Garey L, Ditre JW, Shepherd JM, Viana AG, Kauffman BY, Businelle M. The Role of Anxiety Sensitivity in the Relation Between Pain Intensity with Substance Use and Anxiety and Depressive Symptoms Among Smokers with Chronic Pain. Int J Behav Med. 2020 Dec;27(6):668-676.
  • 13. Feingold D, Brill S, Goor-Aryeh I, Delayahu Y, Lev-Ran S. Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana. J Affect Disord. 2017 August 15;218:1-7.
  • 14. Aubin HJ, Rollema H, Svensson TH, Winterer G. Smoking, quitting, and psychiatric disease: a review. Neurosci Biobehav Rev. 2012 Jan;36(1):271-84.
  • 15. Minichino A, Bersani FS, Calò WK, Spagnoli F, Francesconi M, Vicinanza R, Delle Chiaie R, Biondi M. Smoking behaviour and mental health disorders--mutual influences and implications for therapy. Int J Environ Res Public Health. 2013 Oct 10;10(10):4790-811.
  • 16. Reiss S, McNally RJ. Theoretical Issues in Behaviour Therapy. Editor: Reiss S, Bootzin RR. San Diego, Academic Press, 1985, pp. 107-121.
  • 17. Mantar A, Yemez B, Alkın T. Anxiety sensitivity and its importance in psychiatric disorders. Turk Psikiyatri Derg. 2011 Fall;22(3):187-93. English, Turkish.
  • 18. Zvolensky MJ, Bakhshaie J, Shepherd JM, Peraza N, Garey L, Viana AG, Glover N, Brown JT, Brown RA. Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers. Addict Behav. 2019a Mar;90:55-61.
  • 19. Zvolensky MJ, Garey L, Mayorga NA, Peraza N, Rogers AH, Ditre JW, Orr MF. Pain Severity and Anxiety Sensitivity Interplay Among Exclusive and Dual Electronic Cigarette Users. J Stud Alcohol Drugs. 2019b Mar;80(2):211-219.
  • 20. Heaviness of smoking index - Borland R, Yong HH, O'Connor RJ, Hyland A, Thompson ME. The reliability and predictive validity of the Heaviness of Smoking Index and its two components: findings from the International Tobacco Control Four Country study. Nicotine Tob Res. 2010 Oct;12 Suppl(Suppl 1):S45-50.
  • 21. Reuven SM, Chen TA, Zvolensky MJ, Businelle MS, Kendzor DE, Reitzel LR. Examining the moderating effect of anxiety sensitivity on past-month pain severity and heaviness of smoking among adult smokers experiencing homelessness. Addict Behav. 2021 Jan;112:106610.
  • 22. Leyro TM, Zvolensky MJ, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychol Bull. 2010 Jul;136(4):576-600.
  • 23. Daughters SB, Lejuez CW, Bornovalova MA, Kahler CW, Strong DR, Brown RA. Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. J Abnorm Psychol. 2005 Nov;114(4):729-34.
  • 24. Strong DR, Brown RA, Sims M, Herman DS, Anderson BJ, Stein MD. Persistence on a stress-challenge task before initiating buprenorphine treatment was associated with successful transition from opioid use to early abstinence. J Addict Med. 2012 Sep;6(3):219-25.
  • 25. Moschak TM, Terry DR, Daughters SB, Carelli RM. Low distress tolerance predicts heightened drug seeking and taking after extended abstinence from cocaine self-administration. Addict Biol. 2018 Jan;23(1):130-141.
  • 26. Redmond BY, Salwa A, Bricker JB, Buckner JD, Garey L, Zvolensky MJ. Personalized feedback intervention for individuals with low distress tolerance who smoke cigarettes: A randomized controlled trial of a digital intervention. J Subst Use Addict Treat. 2023 Dec;155:209163
  • 27. Redmond BY, Bizier A, Salwa A, Brown RA, Garey L, Zvolensky MJ. Transdiagnostic Risk Factors for Reasons for Smoking: Evaluating the Concurrent Role of Distress Tolerance and Anxiety Sensitivity. Int J Behav Med. 2024 Oct 31.
  • 28. Niezabitowska A, Rokosz M, Poprawa R. Distress Tolerance is Indirectly Related to Nicotine Use through the Smoking Motives. Subst Use Misuse. 2022;57(5):751-758.
  • 29. Trépanier A, Turcotte S, Foldes-Busque G. Distress tolerance and experience of chronic pain. Encephale. 2022 Dec;48(6):653-660.
  • 30. Couper MP, Tourangeau R, Conrad FG, Singer E. Evaluating the Effectiveness of Visual Analog Scales: A Web Experiment. Social Science Computer Review. 2006;24(2), 227-245.
  • 31. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70.
  • 32. Aydemir Ö. Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale. Turk Psikiyatri Derg. 1997;8:280-7.
  • 33. Gülseren L, Hekimsoy Z, Gülseren Ş, Bodur Z, Kültür S. Depression-anxiety, quality of life and disability in patients with diabetes mellitus. Turk Psikiyatri Derg. 2001;12(2):89 - 98.
  • 34. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1-8.
  • 35. Taylor S, Zvolensky MJ, Cox BJ, Deacon B, Heimberg RG, Ledley DR, Abramowitz JS, Holaway RM, Sandin B, Stewart SH, Coles M, Eng W, Daly ES, Arrindell WA, Bouvard M, Cardenas SJ. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess. 2007 Jun;19(2):176-88. 36. Mantar A, Yemez B, Alkın T. The Validity and Reliability of the Turkish Version of the Anxiety Sensitivity Index-3. Turk Psikiyatri Derg, 2010;21(3): 225- 234.
  • 37. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991; 86: 1119-27.
  • 38. Uysal MA, Kadakal F, Karşidağ C, Bayram NG, Uysal O, Yilmaz V. Fagerström test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks. 2004;52(2):115-121.
  • 39. Clinical Evaluation of Nicotine Dependence. Güncel Göğüs Hastalıkları Serisi, 2017;4(1), 78-89.
  • 40. Simons JS, Gaher RM. The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion. 2005;29:83-102.
  • 41. Sargın AE, Özdel K, Utku Ç, Kuru E, Yalçınkaya Alkar Ö, Türkçapar MH. Distress Tolerance Scale: A Study Of Reliability And Validity. J Cogn Behav Psychother Res 2012; 1(3):152-161.
  • 42. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults—United States, 2019–2021. MMWR Morb Mortal Wkly Rep. 2023;72(14):379–385.
  • 43. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012 Jul 7;380(9836):37-43.
  • 44. Mullins PM, Yong RJ, Bhattacharyya N. Associations between chronic pain, anxiety, and depression among adults in the United States. Pain Pract. 2023 Jul;23(6):589-594.
  • 45. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019 Aug;123(2):e273-e283.
  • 46. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;10(4):287-333.
  • 47. Hall AM, Kamper SJ, Maher CG, Latimer J, Ferreira ML, Nicholas MK. Symptoms of depression and stress mediate the effect of pain on disability. Pain. 2011 May;152(5):1044-1051.
  • 48. Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J. Smoking, smoking cessation, and major depression. JAMA. 1990 Sep 26;264(12):1546-9.
  • 49. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? Spine (Phila Pa 1976). 1993 Jan;18(1):66-71.
  • 50. Atkinson HJ, Slater MA, Patterson TL, Grant I, Garfin SR. Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study. Pain. 1991 May;45(2):111-121
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  • 52. Moylan S, Jacka FN, Pasco JA, Berk M. Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies. BMC Med. 2012 Oct 19;10:123.
  • 53. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking-dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013 Dec;21(6):443-449.
  • 54. Powers JM, LaRowe LR, Garey L, Zvolensky MJ, Ditre JW. Pain intensity, e-cigarette dependence, and cessation-related outcomes: The moderating role of pain-related anxiety. Addict Behav. 2020 Dec;111:106548.
  • 55. Zvolensky MJ, Shepherd JM, Clausen BK, Garey L, Kauffman BY, Heggeness LF, Viana AG, Bizier A. Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers. J Ethn Subst Abuse. 2024 Oct-Dec;23(4):926-946.
  • 56. Svicher A, Zvolensky MJ, Cosci F. Study of the relationship between anxiety sensitivity, smoking abstinence expectancies, nicotine withdrawal, and cigarette dependence among daily smokers. J Addict Dis. 2018 Jan-Jun;37(1-2):55-63.
  • 57. Guillot CR, Blackledge SM, Douglas ME, Cloutier RM, Liautaud MM, Pang RD, Kirkpatrick MG, Leventhal AM. Indirect Associations of Anxiety Sensitivity with Tobacco, Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents. Behav Med. 2020 Apr-Jun;46(2):161-169.
  • 58. Johnson KA, Stewart S, Rosenfield D, Steeves D, Zvolensky MJ. Prospective evaluation of the effects of anxiety sensitivity and state anxiety in predicting acute nicotine withdrawal symptoms during smoking cessation. Psychol Addict Behav. 2012;26(2):289.
  • 59. Brown RA, Lejuez CW, Kahler CW, Strong DR, Zvolensky MJ. Distress tolerance and early smoking lapse. Clin Psychol Rev. 2005 Sep;25(6):713-33.
  • 60. Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015 Jan;141(1):176-212.
  • 61. Schlam TR, Baker TB, Smith SS, Cook JW, Piper ME. Anxiety Sensitivity and Distress Tolerance in Smokers: Relations With Tobacco Dependence, Withdrawal, and Quitting Success†. Nicotine Tob Res. 2020 Jan 27;22(1):58-65.
  • 62. Veilleux JC. The relationship between distress tolerance and cigarette smoking: A systematic review and synthesis. Clin Psychol Rev. 2019 Jul;71:78-89.
  • 63. LaRowe LR, Farris SG, Zvolensky MJ, Ditre JW. Associations Between Past-Month Pain and Distress Intolerance Among Daily Cigarette Smokers. J Stud Alcohol Drugs. 2018 Sep;79(5):781-789.
  • 64. Bakhshaie J, Ditre JW, Langdon KJ, Asmundson GJ, Paulus DJ, Zvolensky MJ. Pain intensity and smoking behavior among treatment seeking smokers. Psychiatry Res. 2016 March 30;237:67-71.
  • 65. Ditre JW, Heckman BW, Zale EL, Kosiba JD, Maisto SA. Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis. Pain. 2016 Jul;157(7):1373-1381.
  • 66. Girdler SS, Maixner W, Naftel HA, Stewart PW, Moretz RL, Light KC. Cigarette smoking, stress-induced analgesia and pain perception in men and women. Pain. 2005 Apr;114(3):372-385.
  • 67. Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull. 2011 Nov;137(6):1065-93.
  • 68. Zale EL, Maisto SA, Ditre JW. Anxiety and Depression in Bidirectional Relations Between Pain and Smoking: Implications for Smoking Cessation. Behav Modif. 2016 Jan;40(1-2):7-28.
Toplam 67 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Psikiyatri
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Hazal Ulusoy 0000-0002-6355-4778

İmran Gökçen Yılmaz-karaman 0000-0003-2821-7749

Esra Ağrıdağ 0000-0002-9872-2858

Hale Kocabacak 0000-0002-0664-4566

Mehmet Sacit Güleç 0000-0002-7107-3798

Gülcan Güleç 0000-0002-3159-5372

Yayımlanma Tarihi 4 Eylül 2025
Gönderilme Tarihi 11 Şubat 2025
Kabul Tarihi 8 Ağustos 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 5

Kaynak Göster

Vancouver Ulusoy H, Yılmaz-karaman İG, Ağrıdağ E, Kocabacak H, Güleç MS, Güleç G. Predictors of Severe Nicotine Dependence in Patients with Chronic Pain. Osmangazi Tıp Dergisi. 2025;47(5):816-27.


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