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Does a history of depression actually mediate smoking-related pain? Findings from a cross-sectional general population-based study.

van Hecke, O.; Torrance, N.; Cochrane, L.; Cavanagh, J.; Donnan, P.T.; Padmanabhan, S.; Porteous, D.J.; Hocking, L.; Smith, B.H.


O. van Hecke

L. Cochrane

J. Cavanagh

P.T. Donnan

S. Padmanabhan

D.J. Porteous

L. Hocking

B.H. Smith


Background: Smokers report more pain and worse functioning. The evidence from pain clinics suggests that depression affects this relationship: The association between smoking and chronic pain is weakened when controlling for depression. This study explored the relationship between smoking, pain and depression in a large general population-based cohort (Generation Scotland: Scottish Family Health Study). Methods: Chronic pain measures (intensity, disability), self-reported smoking status and a history of major depressive disorder (MDD) were analysed. A multivariate analysis of covariance determined whether smoking status was associated with both pain measures and a history of depressive illness. Using a statistical mediation model any mediating effect of depression on the relationship between smoking and chronic pain was sought. Results: Of all 24,024 participants, 30% (n=7162) reported any chronic pain. Within this chronic pain group, 16% (n=1158) had a history of MDD; 7108 had valid smoking data: 20% (n=1408) were current smokers, 33% (n=2351) former and 47% (n=3349) never smokers. Current smokers demonstrated higher pain intensity and pain-related disability scores compared with former and non-smokers (p [less than] 0.001 for all analyses). From the mediation model, the effect on pain intensity decreased (p [less than] 0.001), indicating that the relationship between smoking and a history of depression contributes significantly to the effect of smoking on pain intensity. When applied to smoking-related pain disability, there was no mediation effect. Conclusions: In contrast to smokers treated in pain clinics, a history of MDD mediated the relationship between smoking and pain intensity, but not pain-related disability in smokers in the community.


VAN HECKE, O., TORRANCE, N., COCHRANE, L., CAVANAGH, J., DONNAN, P.T., PADMANABHAN, S., PORTEOUS, D.J., HOCKING, L. and SMITH, B.H. 2014. Does a history of depression actually mediate smoking-related pain? Findings from a cross-sectional general population-based study. European journal of pain [online], 18(9), pages 1223-1230. Available from:

Journal Article Type Article
Acceptance Date Jan 24, 2014
Online Publication Date Feb 27, 2014
Publication Date Oct 31, 2014
Deposit Date Apr 2, 2020
Publicly Available Date Apr 2, 2020
Journal European journal of pain
Print ISSN 1090-3801
Electronic ISSN 1532-2149
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 18
Issue 9
Pages 1223-1230
Keywords Smokers; Pain; Depression; Chronic pain measures; Major depressive disorder
Public URL