Background <p>Many patients with chronic pain smoke cigarettes; they report lacking skills to cope with pain, a smoking trigger.</p> Objective <p>Test the effectiveness of a telephone-delivered, cognitive-behavioral intervention (CBI) incorporating pain self-management to promote smoking cessation among people with chronic pain compared to a smoking cessation counseling control (Standard).</p> Design <p>Randomized trial.</p> Participants <p>Current cigarette smoking, willingness to make a quit attempt, pain for ≥ 3&#xa0;months with worst past week pain intensity of ≥ 4 on the 0–10 pain numerical rating scale.</p> Interventions <p>CBI included 5 telephone sessions integrating smoking cessation and pain self-management, and combination nicotine replacement therapy (NRT). Standard included 5 telephone sessions and NRT.</p> Main Measures <p>Primary outcome used for power analysis was 14-day prolonged abstinence at 6&#xa0;months. Other smoking outcomes included 7-day and 30-day point prevalence abstinence and 7-day prolonged abstinence at 6 and 12&#xa0;months and 14-day prolonged abstinence at 12&#xa0;months. Secondary outcomes included change in pain intensity and interference at 6 and 12&#xa0;months.</p> Key Results <p>Patients were randomly assigned to CBI (n = 189) and Standard (n = 182), stratified by sex. Patients (88% men, median age = 60&#xa0;years) smoked a median of 15 cigarettes per day with moderate pain intensity (5.2 (SD = 1.6)) and pain interference (5.5 (SD = 2.2)). Participation in all 5 counseling calls was higher in CBI (38% vs. 29%), and there was no difference in NRT use (47% vs. 45%). There were no differences by arm in smoking or pain outcomes.</p> Conclusions <p>Our study did not detect a difference in smoking cessation between standard counseling and counseling with enhanced content around pain self-management.</p> Trial Registration <p><a href="https://clinicaltrials.gov/study/NCT02971137">https://clinicaltrials.gov/study/NCT02971137</a> Registered 2016–11-16.</p>