Chronic Pain Linked to Higher Smoking and Vaping Odds

People living with chronic pain are nearly twice as likely to smoke or vape compared to those without persistent pain, according to a large-scale survey published in April 2026. The findings, drawn from a nationally representative sample of U.S. Adults, highlight a significant behavioral overlap between long-term pain conditions and tobacco and nicotine use, raising concerns about compounded health risks in this population.

The study, conducted by researchers at the University of Michigan and published in the journal Pain Medicine, analyzed responses from over 22,000 adults who participated in the 2023 National Health and Wellness Survey. Participants were asked about the presence of chronic pain — defined as pain lasting three months or more — and their current use of cigarettes, e-cigarettes, or other vaping products. After adjusting for age, sex, income, education, and mental health status, individuals with chronic pain showed 1.9 times the odds of current smoking and 1.8 times the odds of vaping compared to those without chronic pain.

The association remained strong even after accounting for comorbidities such as depression and anxiety, which are themselves linked to both chronic pain and substance use. Researchers noted that while the study design cannot establish causation, the consistent strength of the association across different pain conditions — including back pain, arthritis, and neuropathic pain — suggests a meaningful relationship that warrants further investigation.

Dr. Elena Rodriguez, lead author of the study and an epidemiologist at the University of Michigan School of Public Health, explained that individuals with chronic pain may turn to nicotine as a form of self-management. “Nicotine has short-term analgesic properties and can modulate mood, which may make it appealing to people dealing with persistent discomfort,” she said. “However, relying on smoking or vaping for symptom relief carries well-documented risks, including cardiovascular disease, respiratory illness, and potential worsening of pain sensitivity over time.”

Public health experts emphasize that the findings underscore the need for integrated care approaches that address both pain management and tobacco cessation. The U.S. Preventive Services Task Force recommends that clinicians screen all adults for tobacco use and offer evidence-based interventions, including behavioral counseling and FDA-approved medications. For patients with chronic pain, these conversations should be tailored to acknowledge the potential role of nicotine in coping while promoting safer alternatives.

Current clinical guidelines for chronic pain, such as those from the Centers for Disease Control and Prevention and the American College of Physicians, prioritize non-pharmacological therapies like physical therapy, cognitive behavioral therapy, and exercise as first-line treatments. When medication is necessary, non-opioid options are preferred due to the risks associated with long-term opioid use. Nicotine replacement therapies, while not typically indicated for pain, may play a role in cessation efforts for those seeking to quit smoking or vaping.

The study also examined frequency of use and found that among individuals with chronic pain who smoked, a higher proportion reported daily use compared to occasional smoking. Similarly, frequent vaping was more prevalent in this group. Researchers noted that this pattern may reflect dependence rather than situational use, although the survey did not assess nicotine dependence directly.

Limitations of the study include its reliance on self-reported data, which may be subject to recall or social desirability bias. The cross-sectional design prevents conclusions about whether chronic pain leads to increased nicotine use, or whether individuals who smoke or vape are more likely to develop or report chronic pain due to shared risk factors such as inflammation, poor sleep, or sedentary behavior. Future longitudinal studies are needed to clarify the direction of the relationship.

Despite these limitations, the large sample size and adjustment for key confounders strengthen the validity of the observed association. The findings align with prior research showing higher rates of tobacco use among individuals with chronic conditions, including fibromyalgia and migraine. They also highlight a potential gap in routine care: while pain clinics often assess for opioid misuse, screening for tobacco and nicotine use may be less standardized.

Moving forward, experts suggest that integrating tobacco cessation support into pain management programs could improve overall health outcomes. Simple steps such as asking about tobacco use during pain evaluations, offering brief advice, and connecting patients to quitlines or digital cessation tools may help reduce dual burden. As Dr. Rodriguez noted, “Addressing nicotine use isn’t just about preventing lung cancer or heart disease — it’s also about improving the effectiveness of pain treatment and enhancing quality of life for people who are already coping with a significant health challenge.”