Is Smoking Associated with Alcohol-Drug Dependence in Patients with Pain and Chronic Pain Patients? An Evidence-Based Structured Review
Pain Medicine, 08/10/2012
Evidence Based Medicine
Fishbain DA et al. – There is limited consistent indirect evidence that smoking status in patients with pain and chronic pain patients (CPPs) is associated with alcohol–drug and opioid dependence. Smoking status could be a red flag for opioid–dependence development on opioid exposure.Methods
- Six hundred and twenty–three references were found that addressed the areas of smoking, pain, and drug–alcohol dependence.
- Fifteen studies remained after exclusion criteria were applied and sorted into four groupings addressing four hypotheses: patients with pain and CPPs who smoke are more likely than their nonsmoking counterparts to use opioids, require higher opioid doses, be drug–alcohol dependent, and demonstrate aberrant drug–taking behaviors (ADTBs).
- Each study was characterized by the type of study it represented according to the Agency for Health Care Policy and Research (AHCPR) guidelines and independently rated by two raters according to 13 quality criteria to generate a quality score.
- The percentage of studies in each grouping supporting/not supporting each hypothesis was calculated.
- The strength and consistency of the evidence in each grouping was rated by the AHCPR guidelines.
- In each grouping, 100% of the studies supported the hypothesis for that grouping.
- The strength and consistency of the evidence was rated as A (consistent multiple studies) for the first hypothesis and as B (generally consistent) for the other.