Although smoking is commonly known to increase the risks of many types of cancer and cardiovascular disease, some studies show that smoking is linked in different ways to chronic pain. A study that was published in the April 2014 issue of Nicotine & Tobacco Research showed that smokers who were experiencing pain had “lower confidence in their ability to remain abstinent” from smoking and had a much harder time quitting than smokers who do not experience pain. However, smokers in pain had greater motivation to quit smoking than their pain-free counterparts. Joseph Ditre, Ph.D. from the Department of Psychology in Syracuse University and colleagues stated that this is the first study that demonstrated “an association between positive pain status, recent difficulty quitting smoking, and reduced self-efficacy for future smoking abstinence.” This can help health professionals in pain management in identifying causes of pain and possible ways to alleviate pain among smokers.
A larger study that was published in The Journal of Bone & Joint Surgery on December 5, 2012, showed a strong correlation between the prevalence of back pain and smoking among over 5,300 patient records. While non-smokers had reported significantly less pain than smokers, smokers who had quit smoking while receiving care had also significantly less pain. Smokers who continued to smoke during treatment had no significant improvement in pain. While there is increasing evidence that smoking could be linked to chronic pain, not all health care practices and clinics regard smoking as a possible factor which contributes to pain. Occupational therapist Bronwyn Thompson, M.Sc., who practices at the University of Otago in New Zealand, wrote on her blog, Health Skills, that she used to work with a manager who did not think that providing support for patients to quit smoking was relevant to pain management. This did not enable Thompson to use her smoking cessation skills to work with patients who were smokers and suffering from chronic pain. She wrote that some clinicians do not believe that broader health problems are also their concern. Dealing with patients’ chronic pain is “enough for them.”
Although exposure to nicotine from smoking produces an analgesic effect in animal studies, continued exposure can cause the body to develop a higher tolerance and receptor desensitization to its pain-numbing effects. A detailed 2010 review published in Anesthesiology stated that withdrawal symptoms of nicotine can lead to anxiety, depressed mood, dysphoria and gastrointestinal symptoms due to decreased nicotine levels in the blood. Chronic smoking can also change pain perception, which is different between smokers and non-smokers. Gender and the specific type of pain are also factors in pain experience. In a study from the University of California Irvine, researchers found that men who are deprived from nicotine had a higher threshold and tolerance to electrical pain compared to non-smokers. Another study that involved men and women found that women had a greater threshold and tolerance to tourniquet-induced ischemic pain, while male smokers are more tolerant to cold pressure pain. However, there was no difference in pain threshold or tolerance in heat pain for either sexes or between smokers and non-smokers.
Although there is an increasing number of evidence that smoking is linked to chronic pain, clinicians like Thompson should not feel helpless if they are not trained in smoking cessation treatments. They can refer their patients to various websites that can provide some help, such as the Guide to Quitting Smoking from the American Cancer Society, New Zealand’s Quitline and Australia’s Smokefree site. Being aware and educated of the link between smoking and pain is one of the earliest interventions that both clinicians and patients can use to become pain-free. Of course, quitting smoking can help a lot.
By Nick Ng