Increasing Cessation Motivation and Treatment Engagement Among Smokers in Pain: A Pilot Randomized Controlled Trial

Tobacco smokers with co-occurring pain report greater difficulty quitting, face unique cessation challenges, and may benefit from targeted smoking interventions. We developed and tested a brief motivational intervention aimed at increasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers in pain. Nontreatment seeking daily cigarette smokers with chronic pain (N = 76, 57.9% women, 52.6% White) were randomized to the targeted or ask, advise, refer (AAR) intervention. The targeted intervention included personalized feedback and pain-smoking psychoeducation to help participants develop discrepancy between continued smoking and desired pain outcomes. At postintervention, the targeted intervention (vs. AAR) increased knowledge of pain-smoking interrelations and several indices of motivation to quit smoking (ps =.01). Participants who received the targeted intervention were also more likely to accept information about and report intention to engage evidence-based cessation treatments (ps =.05). Increased knowledge of pain-smoking interrelations mediated postintervention effects on motivation to quit and willingness to learn about treatments. At 1-month follow up, gains in knowledge of pain-smoking interrelations were maintained (p =.009). Participants who received the targeted intervention were more likely to report having subsequently engaged cessation treatment (p =.019), but this was not mediated by increased knowledge of pain-smoking interrelations. Smokers with chronic pain may benefit from targeted interventions that address smoking in the context of pain.