Background: Approximately 20% of Veterans smoke. Like smoking, pain is frequently reported by Veterans and smoking is associated with concurrent pain intensity. A reciprocal biopsychosocial model of pain and smoking is hypothesized whereby pain and smoking mutually maintain each other resulting in a cycle marked by elevations in both. More than 50% of patients with chronic pain smoke and standard smoking cessation interventions are largely ineffective for them – in part because pain is a trigger to smoke. Significance: In a recently completed comparative effectiveness trial (IIR15-092), a standard smoking cessation protocol (including pharmacotherapy) was compared to an integrated evidence-based pain and smoking cessation intervention (PASS) among Veterans with chronic pain. At 6-month follow-up, 12% of the patients in the PASS condition reported a 30-day point prevalence abstinence from smoking compared to 6% in the standard protocol. The PASS condition also demonstrated a 6-month improvement in pain interference (34% reported a 30% reduction in pain interference) compared to 19% in the standard protocol. Depressive symptoms were found to have a significant moderating effect such that those with clinically meaningful depression achieved a lower cessation rate relative to non-depressed (8% vs 17%). Though PASS was significant (and promising), the intervention arm did not surpass the superiority threshold (15%) and it did not achieve the expected 20% cessation rate. Accordingly, a more intense intervention is needed to optimize smoking cessation among non-depressed Veterans with pain. Future efforts will then need to augment the intervention for those who are depressed. Innovation & Impact: This proposal augments the PASS intervention with Interactive Voice Response (IVR) to optimize the effectiveness of the intervention. IVR allows patients to interact with a computer-operated phone system and receive personalized asynchronous feedback to reinforce PASS skill acquisition, and utilization. Specific Aims: AIM 1: Determine whether the existing integrated pain and smoking cessation (PASS intervention) augmented with IVR (PASS-IVR) is superior to treatment as usual (e.g., referral to standard VA smoking cessation clinic) enhanced with pharmacotherapy tele-consult (E-TAU) at 6 (primary endpoint) and 12 months on cigarette abstinence rates among non-depressed Veterans with chronic pain. Hypotheses 1.1: Prolonged abstinence rates and point prevalence abstinence rates will be significantly higher among non-depressed Veterans with chronic pain who receive PASS-IVR compared with those in E-TAU. AIM 2: Determine whether PASS-IVR is superior to E-TAU at 6 (primary endpoint) and 12 months on pain interference. Hypothesis 2.1: Non-depressed Veterans in PASS-IVR will report significantly lower pain interference relative to E-TAU. AIM 3: Examine key components of the intervention process to inform future program implementation using the RE-AIM framework which con...