Chronic Pain Linked to Nearly Double the Risk of Smoking and Vaping, New Survey Finds

People living with chronic pain are significantly more likely to smoke cigarettes or use e-cigarettes than those without persistent pain, according to a large-scale national survey published in Preventive Medicine Reports. The study, which analyzed data from over 20,000 U.S. Adults, found that individuals reporting chronic pain were nearly twice as likely to be current smokers and had substantially higher odds of vaping, highlighting a critical intersection between pain management and substance use that demands greater clinical attention.

Understanding the Link Between Chronic Pain and Nicotine Use

Chronic pain, defined as pain lasting three months or longer, affects an estimated 50 million U.S. Adults, according to the Centers for Disease Control and Prevention (CDC). Beyond its physical toll, chronic pain is strongly associated with mental health conditions such as depression and anxiety, reduced quality of life, and increased healthcare utilization. Emerging research now suggests it may as well be a significant risk factor for tobacco and nicotine product use.

The recent study, led by researchers at the University of California, San Francisco, utilized data from the 2020–2021 National Health Interview Survey (NHIS), a nationally representative survey conducted by the CDC’s National Center for Health Statistics. Participants were asked about pain status, smoking habits, and e-cigarette use. After adjusting for age, sex, race/ethnicity, income, education, and mental health status, the analysis revealed:

• Adults with chronic pain had 1.8 times higher odds of being current cigarette smokers compared to those without chronic pain.
• They also had 1.9 times higher odds of using e-cigarettes (vaping).
• The association was strongest among individuals reporting high-impact chronic pain — pain that frequently limits life or work activities.

“These findings suggest that nicotine use may be a coping mechanism for some people dealing with persistent pain,” said Dr. Teresa Evans, lead author of the study and assistant professor of epidemiology at UCSF. “While nicotine can provide short-term relief by modulating pain pathways in the brain, long-term use carries serious health risks, including cardiovascular disease, respiratory illness, and cancer.”

Why Might Chronic Pain Increase the Risk of Smoking and Vaping?

The relationship between chronic pain and nicotine use is likely bidirectional and influenced by multiple biological, psychological, and social factors:

Biological Mechanisms

Nicotine activates nicotinic acetylcholine receptors in the brain and spinal cord, which can modulate pain perception and release neurotransmitters like dopamine and endogenous opioids. This may provide temporary analgesic effects, particularly for neuropathic or musculoskeletal pain. However, tolerance develops quickly, leading to increased use and dependence.

Psychological and Behavioral Factors

Chronic pain is often accompanied by stress, anxiety, and depression — all of which are independent risk factors for smoking initiation and relapse. Nicotine’s short-term mood-enhancing effects may create it an appealing, albeit harmful, self-medication strategy. The routine of smoking or vaping can become a learned behavior tied to pain flare-ups or emotional distress.

Healthcare Access and Treatment Gaps

Many individuals with chronic pain report inadequate pain management and limited access to multimodal treatments such as physical therapy, cognitive behavioral therapy, or non-opioid medications. In the absence of effective, accessible alternatives, some may turn to nicotine products as a readily available coping tool.

Implications for Clinical Practice

The study’s authors emphasize that healthcare providers should routinely assess nicotine use in patients with chronic pain and integrate smoking cessation support into pain management plans.

“Asking about tobacco and e-cigarette use should be as standard as asking about pain levels,” said Dr. Evans. “We need to treat the whole person — not just the pain symptom. Offering evidence-based cessation resources, such as nicotine replacement therapy, prescription medications like varenicline or bupropion, and behavioral counseling, can significantly improve both pain outcomes and overall health.”

Integrated care models that combine pain specialists, primary care physicians, and behavioral health providers are best positioned to address this dual challenge. The CDC recommends the 5 A’s framework (Request, Advise, Assess, Assist, Arrange) for tobacco cessation in clinical settings — a strategy that can be seamlessly incorporated into chronic pain visits.

Public Health Considerations

Given the prevalence of both chronic pain and nicotine use, the findings have broader implications for public health policy. Anti-smoking campaigns and vaping prevention efforts may need to be tailored to individuals living with chronic pain, addressing not only the risks of nicotine but also offering accessible alternatives for pain and stress relief.

Expanding insurance coverage for non-pharmacological pain therapies, increasing funding for pain management research, and reducing stigma around both chronic pain and addiction are essential steps toward breaking this cycle.

Key Takeaways

• Adults with chronic pain are nearly twice as likely to smoke cigarettes or use e-cigarettes compared to those without chronic pain.
• The association remains strong even after accounting for mental health, demographics, and socioeconomic factors.
• Nicotine may offer short-term pain or mood relief but carries significant long-term health risks.
• Clinicians should screen for tobacco and e-cigarette use in all chronic pain patients and offer integrated cessation support.
• Improving access to comprehensive, multimodal pain care may reduce reliance on harmful coping strategies like nicotine use.

Frequently Asked Questions (FAQ)

Does vaping help with chronic pain?

While some individuals report temporary relief from pain or stress when vaping, there is no scientific evidence that e-cigarettes are an effective or safe long-term treatment for chronic pain. In fact, vaping carries risks to lung and cardiovascular health and can lead to nicotine dependence.

Can quitting smoking worsen chronic pain?

Some people may experience a temporary increase in pain or discomfort during nicotine withdrawal, but this typically improves within a few weeks. Studies show that quitting smoking is associated with improved pain outcomes over time, likely due to reduced inflammation and better circulation.

What are safer alternatives to smoking or vaping for pain relief?

Evidence-based options include physical therapy, exercise, cognitive behavioral therapy (CBT), mindfulness-based stress reduction, acupuncture, and certain medications such as antidepressants or anticonvulsants for neuropathic pain. A personalized pain management plan developed with a healthcare provider is the safest and most effective approach.

Where can I get help to quit smoking or vaping?

Free resources are available through Smokefree.gov, which offers texting programs, apps, and live chat support. The national quitline (1-800-QUIT-NOW) provides confidential coaching and can connect callers with local services. Many health insurance plans also cover cessation medications and counseling.

This article is based on a peer-reviewed study published in Preventive Medicine Reports and data from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS). All information reflects current medical understanding as of 2024.