Chronic pain is one of the most common long-term health conditions affecting adults in the United States, and it is closely linked with higher rates of tobacco use. A recent large-scale analysis using data from the National Health Interview Survey (NHIS) between 2014 and 2023 examined how cigarette smoking, e-cigarette use, and dual use have changed over time in adults with and without chronic pain.
The study highlights an important public health issue: although smoking rates are declining overall, people living with chronic pain continue to use tobacco at significantly higher rates than those without pain.
This blog breaks down the key findings, trends, and implications in a clear way.
The research was a serial cross-sectional analysis using NHIS data collected from 2014 to 2023, excluding 2022. The final sample included 195,632 US adults. Chronic pain was defined based on self-reported pain occurring every day or most days in the past three months.
Researchers analyzed three main outcomes:
The study adjusted for age, sex, and race and ethnicity, ensuring more accurate comparisons between groups. The analysis was conducted in 2025 and used nationally representative weighted data from NHIS.
One of the strongest findings is that cigarette smoking remains significantly more common among adults with chronic pain compared to those without.
Although smoking decreased in both groups over time, the decline was slower among individuals with chronic pain.
This suggests that while public health efforts to reduce smoking are working, they are less effective in populations dealing with chronic pain.
E-cigarette use increased significantly over the study period in both groups.
The increase was similar across both populations, meaning chronic pain does not appear to accelerate or slow down vaping adoption in a major way.
However, adjusted results showed that people with chronic pain still had slightly higher e-cigarette use overall.
Dual use refers to individuals who use both cigarettes and e-cigarettes. This pattern is often associated with higher nicotine dependence and more complex quitting behavior.
The study found that dual use declined in both groups:
Even though rates decreased, adults with chronic pain consistently had higher dual use compared to those without pain.
An important part of the analysis showed a clear relationship between pain frequency and smoking behavior.
People who reported more frequent pain were more likely to smoke cigarettes. This pattern was consistent across all years of the study.
The findings suggest a dose-response relationship, where increasing pain severity is associated with increasing tobacco use.
The study also examined high-impact chronic pain (HICP), defined as pain that frequently limits daily activities.
In 2023:
This indicates that disabling pain is linked to even higher smoking rates.
For e-cigarette use and dual use, differences between HICP and non-HICP groups were less pronounced.
The study does not prove causation, but previous research suggests several possible explanations:
This bidirectional relationship makes tobacco cessation more complex in this population.
These findings highlight a key challenge in tobacco control: general smoking declines are not equally experienced across all populations.
Adults with chronic pain remain a high-risk group for tobacco use, particularly cigarette smoking and dual use.
Public health strategies may need to:
Without targeted support, disparities in tobacco use may persist even as national smoking rates continue to fall.
Like all research, this study has limitations:
Despite these limitations, the large nationally representative sample strengthens the reliability of the findings.
Between 2014 and 2023, tobacco use in the United States declined overall, but adults with chronic pain consistently showed higher rates of cigarette smoking, e-cigarette use, and dual use compared to those without chronic pain.
While vaping increased and dual use declined in both groups, smoking remains disproportionately high among people living with chronic pain. The slower decline in cigarette use within this population highlights an ongoing health disparity.
These findings suggest that chronic pain management and tobacco cessation should be more closely integrated in healthcare settings to reduce long-term risks.
Lazzari JL, Rubenstein D, Powers JM, McClernon FJ, Pacek LR, Sweitzer MM. Prevalence of Tobacco Use in Adults With Chronic Pain: Results From the National Health Interview Survey 2014–2023. National Health Interview Survey analysis (2014–2023), published study summary data.
This article is a paraphrased educational summary based on published research data. It is intended for informational purposes only and does not provide medical advice, diagnosis, or treatment. Readers should consult qualified healthcare professionals for personal medical guidance or tobacco cessation support.
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