Using Very Low Nicotine Content Cigarettes as a Strategy to Disrupt the Pain-Smoking Reinforcement Cycle

使用尼古丁含量极低的香烟作为扰乱吸烟强化循环的策略

• 批准号: 10303720
• 负责人: Maggie M Sweitzer
• 金额: $ 24.15万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10303720
• 关键词: Abstinence; Acute Pain; Aftercare; Analgesics; Attenuated; Back Pain; Behavior; Behavioral; Biological Markers; Chronic; Cigarette; Cognition; Complex; Dependence; Development; Ecological momentary assessment; Extinction (Psychology); Feedback; Frequencies; General Population; Goals; Health; Health Care Costs; Hour; Hyperalgesia; Individual; Intention; Intervention; Laboratory Finding; Laboratory Study; Learning; Measures; Motivation; Negative Reinforcements; Nicotine; Nicotine Dependence; Nicotine Withdrawal; Pain; Pain intensity; Pain interference; Participant; Persons; Population; Price; Procedures; Productivity; Psychological reinforcement; Randomized; Reporting; Research; Risk; Risk Factors; Role; Self Efficacy; Severities; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Testing; Time; Tobacco smoking behavior; Tobacco use; Visit; Vulnerable Populations; Withdrawal; Withdrawal Symptom; Work; chronic back pain; chronic pain; chronic painful condition; cigarette smoke; cigarette smoking; comorbidity; coping; craving; design; epidemiology study; expectation; improved; insight; interest; low nicotine content cigarette; negative affect; pain behavior; pain outcome; pain perception; pain relief; pain symptom; reduce symptoms; smoking abstinence; smoking cessation; tool

Tobacco smoking and chronic pain are highly comorbid conditions. Smoking and pain have been proposed to influence each other through a reciprocal positive feedback loop, in which pain increases motivation to smoke and smoking worsens pain over time. Nicotine has been shown to provide mild, short-term anti-nociceptive effects, which may contribute to powerful negative reinforcement learning. Conversely, smoking withdrawal exacerbates pain, presenting a potential barrier to smoking cessation. The goal of the proposed research is to examine whether switching to Very Low Nicotine Content (VLNC) cigarettes can directly weaken the pain-smoking reinforcement cycle, and attenuate withdrawal-induced hyperalgesia, among smokers with chronic pain. The research will employ a randomized between-subjects design to evaluate the effects of smoking VLNC’s versus Normal Nicotine Content (NNC) cigarettes on smoking behavior, pain, withdrawal symptoms and motivation to quit among daily smokers with chronic (>3 months) non-cancer back pain. Moreover, ecological momentary assessments (EMA) will be used to examine changes in bidirectional associations between pain, smoking urge and behavior as a function of cigarette condition. Participants will complete 1-week of baseline EMA while smoking their usual brand of cigarettes to familiarize them with study procedures; they will then be randomized to 4-weeks of NNCs or VLNCs. EMA will continue during weeks 1 and 4 of study cigarette use, and will assess smoking behavior and urge, negative affect, and pain intensity and interference. Participants will attend weekly in-person visits to obtain biomarker verification of cigarette compliance, and will complete measures of nicotine dependence, self-efficacy and motivation to quit, and pain-related coping. At the start of the study and at the end of 4-weeks of study cigarette use, a 24-hr smoking abstinence test will be used to assess withdrawal symptoms and withdrawal-induced hyperalgesia. In general, we hypothesize that switching to VLNCs will attenuate the bidirectional associations between smoking and pain as assessed via EMA, and will lead to decreased symptoms of withdrawal and pain during the 24-hour abstinence test. We also hypothesize that VLNCs will be associated with improvements in abstinence self-efficacy and intention to quit smoking, and decreased reliance on smoking to cope with pain. These results will provide critical insights into the role of nicotine in maintaining smoking/pain associations and the potential for VLNCs to extinguish learned associations to promote smoking cessation in this vulnerable population.

吸烟和慢性疼痛是高度共存的疾病。 有人建议通过相互的正反馈循环相互影响，其中 疼痛会增加吸烟的动机，而随着时间的推移，吸烟会加剧疼痛。 经证明可提供轻微、短期的抗伤害作用，这可能有助于产生强大的作用 离线负强化学习，戒烟会加剧疼痛，呈现 拟议研究的目标是检查戒烟的潜在障碍。 转用极低尼古丁含量（VLNC）香烟是否可以直接削弱尼古丁含量 疼痛吸烟强化循环，并减弱戒断引起的痛觉过敏，其中 该研究将采用随机受试者间设计来研究患有慢性疼痛的吸烟者。 评估吸 VLNC 香烟与正常尼古丁含量 (NNC) 香烟对健康的影响 日常吸烟者的吸烟行为、疼痛、戒断症状和戒烟动机 慢性（> 3 个月）非癌症背痛此外，生态瞬时评估。 （EMA）将用于检查疼痛、吸烟之间双向关联的变化 参与者将完成为期 1 周的吸烟状况的冲动和行为。 在吸常用品牌香烟的同时进行基线 EMA 以使他们熟悉研究 然后，他们将被随机分配到为期 4 周的 NNC 或 EMA 继续治疗。 在研究吸烟的第 1 周和第 4 周期间，将评估吸烟行为和冲动， 参与者将每周亲自参加一次负面影响、疼痛强度和干扰。 访问以获得卷烟合规性的生物标志物验证，并将完成以下措施： 尼古丁依赖、自我效能和戒烟动机以及与疼痛相关的应对方式。 该研究在 4 周吸烟研究结束时进行 24 小时戒烟测试 用于评估戒断症状和戒断引起的痛觉过敏。 研究人员认为，切换到 VLNC 将削弱之间的双向关联 通过 EMA 评估吸烟和疼痛，并将导致戒断症状减轻 我们还发现 VLNC 将会受到影响。 与戒烟自我效能和戒烟意愿的改善相关，以及 减少对吸烟来应对疼痛的依赖。这些结果将为我们提供重要的见解。 尼古丁在维持吸烟/疼痛关联中的作用以及 VLNC 的潜力 消除旨在促进这一弱势群体戒烟的学术协会。