Smoking and pain


Something I’ve noticed many times is the number of people experiencing chronic pain who also smoke. It used to be thought that people who smoke perhaps had poorer health behaviours which lead them to be less fit, less careful about eating well, and perhaps to having poorer responses to stressors generally. And I’ve heard it said that people who smoke have ‘addictive personalities’. Well it’s not quite a simple as either explanation – but it’s time to put some of the evidence forward about smoking, nicotine, and pain.

This is not an exhaustive review by any means, just a couple of papers that I thought might help when considering whether to suggest quitting smoking to people who have ongoing pain.
I ought to add that the studies I refer to don’t demonstrate causation – they are correlational studies, which mean that there is an association between smoking and chronic pain, but we don’t know whether the relationship is direct, or perhaps mediated through other things – and I’ve suggested some above.
Despite this, here are some papers that are quite persuasive.

The first is a large national study published in 2006, specifically looking at tobacco smoking and pain in the general population – quite different from our hospital patients, or those directly seeking treatment. Quoting directly from the abstract: Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors. Female former heavy smokers had an adjusted odds ratio (OR) of 1.6 (95% confidence interval, CI, 1.2-2.2) and male former heavy smokers had an adjusted OR of 1.4 (CI 1.1-1.8) for higher numbers of pain locations compared to never smoking women and men respectively (female current smokers: OR 1.4, CI 1.0-1.9; male current smokers: OR 1.3, CI 1.1-1.7).

The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers.

Well, that’s quite high odds! And sadly, it doesn’t seem to make a lot of difference whether you’ve stopped smoking or continue to smoke – the odds are still high.

A second study worth considering is this one published in 2005, where people consulting a GP for the first time with acute low back pain were followed. Again quoting from the abstract: At 4 weeks and 3 months 76% of the patients had recovered. Mean pain intensity and mean disability scores dropped 58% and 68%, respectively, of initial levels during the 3 months. The proportion with sickness absence was 8% at 4 weeks and 6% at 3 months. Several sociodemographic, clinical, and psychological factors were of prognostic value. Compared with their respective reference categories, age above 45 years (odds ratio 4.4, 95% confidence interval 1.4-14.0), smoking (3.0, 1.1-8.5), two or more neurological signs (4.6, 1.4-14.9), a score of >90 on the psychosocial screening (3.1, 1.0-9.4), and high levels of distress (4.1, 1.3-12.8) were the best prognostic factors of nonrecovery at 3 months.

And a final study worth mentioning is a very recently published one by Ryall and colleagues, studying people attending primary care and physiotherapy for arm pain: Altogether, 313 (83%) of 375 subjects completed follow-up, including 53% with ‘continuing’ and 24% with ‘unremitting’ pain. ‘Continuing’ pain was predicted most strongly by male sex (OR 1.9, 95% CI 1.2-3.2) (this association was restricted largely to the elbow), higher frequency of pain in the past month at baseline (OR 2.5, 95% CI 1.1-5.6), chronic pain at sites outside the arm (ORs 1.6-2.4 for different sites) and current smoking (OR 3.3, 95% CI 1.6-6.6). There were also indications that mental health and fear-avoidance beliefs influenced prognosis. Predictors for the other two adverse outcomes were similar.

Curious – some very strong pointers that smoking increases the risk of persistent pain and poorer recovery from acute pain, yet I’m not sure that I’ve ever heard that in public health messages about smoking, and I’ve not yet heard of quitting smoking efforts targeting people with chronic pain. Time for action? I think so.
BTW I don’t know why I get smiley’s through my posts – any geeks out there able to tell me? Can’t see it in the HTML code, but then again, I’m not a technophile…

Grotle, M., Brox, J. I., Veierod, M. B., Glomsrod, B., Lonn, J. H., & Vollestad, N. K. (2005). Clinical course and prognostic factors in acute low back pain: patients consulting primary care for the first time. Spine, 30(8), 976-982

John, U., Hanke, M., Meyer, C., Volzke, H., Baumeister, S. E., & Alte, D. (2006). Tobacco smoking in relation to pain in a national general population survey. Preventive Medicine, 43(6), 477-481.

Ryall, C., Coggon, D., Peveler, R., Poole, J., & Palmer, K. T. (2007). A prospective cohort study of arm pain in primary care and physiotherapy–prognostic determinants. Rheumatology, 46(3), 508-515.

6 comments

  1. Smoking Sabotages Chronic Pain Management
    September 16th, 2008
    You see it in the media all the time now—the “evils” of smoking. If you review research from credible sources e.g., The American Heart Association, The Food and Drug Administration, or maybe WebMD you will find information that states—“Tobacco addiction, the second-leading cause of death in the world, is a culprit for approximately 5 million deaths each year or 1 in 10 adult deaths.” For many who smoke it is much more than “just a habit.”

    You can also go to the National Institute on Drug Abuse and check out their Research Report Series: Tobacco Addiction and review current scientific up-to-date research about the true nature of nicotine addiction.

    What I haven’t seen very much concerns how smoking impacts chronic pain management. Today I ran across a Blog site “Skills for Healthy Living: A Blog for Health Providers.” One posting I saw was titled “Smoking and Pain” that was posted on June 19, 2008 by adiemusfree. I want to include a few excerpts from that posting. If you want to read the entire posting go to Smoking and Pain.

    A large national study published in 2006, specifically looking at tobacco smoking and pain in the general population – quite different from our hospital patients, or those directly seeking treatment. Quoting directly from the abstract: “Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors.”

    The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers. Well, that’s quite high odds! And sadly, it doesn’t seem to make a lot of difference whether you’ve stopped smoking or continue to smoke – the odds are still high.

    Curious – some very strong pointers that smoking increases the risk of persistent pain and poorer recovery from acute pain, yet I’m not sure that I’ve ever heard that in public health messages about smoking, and I’ve not yet heard of quitting smoking efforts targeting people with chronic pain. Time for action? I think so.

    To read more about my views about smoking please go to my article Smoking and Recovery Just Don’t Mix that you can download for free on our Ariticles page.

    If you want to learn more about the Addiction-Free Pain Management® System please check out our website at http://www.addiction-free.com. To learn more about how to develop an effective chronic pain management plan please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To look for my upcoming trainings please go to our Calendar page.

    To read our latest Chronic Pain Solutions Newsletter please click here. To sign up for Chronic Pain Solutions, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

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