Date of Award

December 2017

Degree Type


Degree Name

Master of Science (MS)




Stephen A. Maisto


addiction, nicotine, pack-years, pain reactivity, quantitative sensory testing, tobacco

Subject Categories

Social and Behavioral Sciences


The pack-years formula is a widely used estimate of lifetime tobacco smoking exposure, and greater pack-years have been associated with greater risk of chronic pain development and poorer pain-related outcomes among smokers with chronic pain. The pathophysiology underlying these associations is poorly understood. Regular tobacco smoking exposure may dysregulate homeostatic pain processes, producing an allostatic state of pain facilitation. Maladaptive pain mechanisms, such as central and peripheral sensitization, are chronic pain risk factors. Yet, no published research has involved a determination of the relation between lifetime-smoking exposure and dysregulated pain processing. The current study used hierarchical linear regression analyses to test pack-years of tobacco smoking as a predictor of (1) spontaneous pain reporting (current pain severity, pain frequency in the last 180 days) among a sample of 228 daily smokers without chronic pain, and (2) experimental capsaicin-induced pain reactivity (pain intensity, area of flare, mechanical pain sensitivity, and area of mechanical hyperalgesia) among 101 daily smokers without chronic pain. Gender and alcohol-related factors (consumption and dependence) were explored as statistical moderators. As hypothesized, results indicated that pack-years smoking was positively and significantly associated with spontaneous current pain severity, past 180-day pain frequency, experimental pain intensity, mechanical pain sensitivity ratings, and area of mechanical hyperalgesia. Pack-years smoking was not significantly associated with neurogenic flare. Moderation analyses produced null results. These findings implicate central sensitization, but not peripheral sensitization, as a potentially relevant factor that may underlie the association between chronic tobacco smoking and increased risk for persistent pain development.


Open Access



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