Assessing the Association of Smoking and Alcohol Consumption With Chronic Pain in Depression and Anxiety Disorders

Previous studies have observed the protective effects of alcohol and the deleterious effects of smoking on chronic pain in the general population. Interestingly, alcohol and smoking were negatively associated with the severity and status of depression and anxiety. Meanwhile, depression and anxiety are associated with an increased perception of pain severity. However, little is known regarding the associations of alcohol and smoking with chronic pain in people with depression and anxiety. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Anxiety was measured with items based on the Generalized Anxiety Disorder-7 (GAD-7). We used logistic and liner regression models to examine associations between smoking, alcohol consumption, and 8 pain phenotypes, including (1) headache; (2) facial pain; (3) neck or shoulder pain; (4) back pain; (5) stomach or abdominal pain; (6) hip pain; (7) knee pain; and (8) multisite chronic pain. Additionally, we did subgroup analysis in the non-depression and anxiety groups and comorbid anxiety-depression group to test if there were differences. Our results found that alcohol consumption was negatively associated with headache in depression group (odds ratio (OR) = 0.71, P = 0.007), which was also found in anxiety group (OR = 0.63, P = 0.002), comorbid anxiety and depression group (OR = 0.68, P = 0.025), and non-depression and anxiety group (OR = 0.72, P = 0.002). We observed that smoking was positively associated with back pain in depression group (OR = 1.14, P = 0.016) and mild to moderate depression group (OR = 1.13, P = 0.049). Also, positive associations of smoking with hip pain were found in the anxiety group (OR = 1.37, P = 0.001) and comorbid anxiety and depression group (OR = 1.31, P = 0.022). Our research indicated that for participants with depression and anxiety, alcohol consumption was negatively associated with most of the pain phenotypes, while smoking was positively associated with most of the 8 pain phenotypes.