Does a history of depression actually mediate smoking-related pain? findings from a cross-sectional general population-based study

O. van Hecke (Lead / Corresponding author), N. Torrance, L. Cochrane, J. Cavanagh, P. T. Donnan, S. Padmanabhan, D. J. Porteous, L. Hocking, B. H. Smith

    Research output: Contribution to journalArticlepeer-review

    6 Citations (Scopus)


    Smokers report more pain and worse functioning. The evidence from pain clinics suggests that depression affects this relationship: The association between smoking and chronic pain is weakened when controlling for depression. This study explored the relationship between smoking, pain and depression in a large general population-based cohort (Generation Scotland: Scottish Family Health Study).

    Chronic pain measures (intensity, disability), self-reported smoking status and a history of major depressive disorder (MDD) were analysed. A multivariate analysis of covariance determined whether smoking status was associated with both pain measures and a history of depressive illness. Using a statistical mediation model any mediating effect of depression on the relationship between smoking and chronic pain was sought.

    Of all 24,024 participants, 30% (n=7162) reported any chronic pain. Within this chronic pain group, 16% (n=1158) had a history of MDD; 7108 had valid smoking data: 20% (n=1408) were current smokers, 33% (n=2351) former and 47% (n=3349) never smokers. Current smokers demonstrated higher pain intensity and pain-related disability scores compared with former and non-smokers (p<?0.001 for all analyses). From the mediation model, the effect on pain intensity decreased (p?<?0.001), indicating that the relationship between smoking and a history of depression contributes significantly to the effect of smoking on pain intensity. When applied to smoking-related pain disability,
    there was no mediation effect.

    In contrast to smokers treated in pain clinics, a history of MDD mediated the relationship between smoking and pain intensity, but not pain-related disability in smokers in the community.

    Original languageEnglish
    Pages (from-to)1223-1230
    Number of pages8
    JournalEuropean Journal of Pain
    Issue number9
    Early online date27 Feb 2014
    Publication statusPublished - Oct 2014


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