Nicotine dependence criteria and nicotine withdrawal symptoms in relation to pain among an adult general population sample

Background: Evidence has shown that people who have smoked at any point in life have a higher probability of pain than those who have never smoked. The goal of this study was to analyze whether there are associations between nicotine dependence including nicotine withdrawal with pain and the number of pain locations. Methods: Data stems from a cross-sectional survey study with a probability sample of residents of a northern German area with 4075 study participants, aged 18-64 years (participation rate 70.2%). Face-to-face in-home computer-aided interviews (Composite International Diagnostic Interview) were used to assess single pain locations, the diagnostic criteria of nicotine dependence, alcohol dependence, depressive, and anxiety disorders according to the Diagnostic and Statistical manual of the American Psychiatric Association (DSM-IV). Results: Ever smokers with three or more nicotine dependence criteria after controlling for alcohol dependence, depressive, anxiety disorders, age and gender revealed an odds ratio (OR) of 4.2 (95% confidence interval, CI, 2.0-9.0) compared to ever smokers without nicotine dependence criteria, and ever smokers with four or more nicotine withdrawal symptoms displayed an OR of 3.6 (CI 1.5-8.7) compared to ever smokers who had not experienced withdrawal symptoms. Current smokers who used 20 or more cigarettes per day had an OR of 0.5 (CI 0.3-0.8) of experiencing pain in three or more locations compared to former smokers. Conclusion: Nicotine dependence criteria are associated with a higher probability of pain than having no nicotine dependence criteria in this general population sample.