Assessment of mood and smoking behavior in chronic pain patients using ecological momentary assessment

Abstract

Objective. Little is known about the association between mood and smoking behavior in individuals with chronic pain. Typically, prospective studies have relied on retrospective recall of past mood and smoking events. Ecological momentary assessment (EMA) is an innovative method for collecting real-time data on smoking and its determinants The main goal of this study was to evaluate the association between mood and smoking behavior in chronic pain patients using this method. Additionally, we examined whether personality traits of neuroticism and extraversion moderate this association. Methods. At baseline, participants completed sociodemographic, tobacco use, and psychosocial measures followed by a one-week period of mood and smoking assessments using handheld computers. Multilevel linear models (MLM) were used to evaluate negative and positive mood across four smoking events. Results. Participants (N = 36; 67% women, 39% Caucasian) were smokers with 58% reporting severe nicotine dependency. Mean baseline worst pain rating in the past week = 8.6 (SD = 1.5) and participants had high levels of psychological distress (mean total score on the Mental Health Inventory = 45.5 [SD = 22.5]). Principal component analysis of EMA mood ratings yielded two subscales: positive and negative mood. MLM showed that participants reported higher levels of negative mood before smoking compared with after smoking ( p < .001) and not smoking and no intention to smoke compared with after smoking (p = .03). Participants' levels of positive mood were not different across smoking events. Neuroticism but not extraversion was found to moderate the association between smoking behavior and mood under the conditions of not smoking and after smoking (p = .001). Conclusions . These findings confirm within-person differences in negative mood across different smoking events in pain patients which are influenced by personality traits. One possible explanation for these findings is that pain patients may use smoking as a means to decrease negative affect. This work might have clinical implications for smoking cessation interventions. Future studies should investigate whether pain or other variables modify the association between mood and smoking, and clarify whether tobacco interventions in pain populations should be tailored to the emotional status of patients.