
- Vol 38, Issue 2
- Volume 02
Pain and Smoking: Is There an Association?
Two recent papers look at the subtle and surprising links between smoking and pain in different parts of the body.
PAIN MANAGEMENT
The association between smoking cigarettes and the risk of developing serious and potentially fatal health problems (most notably cardiovascular diseases, pulmonary diseases, and cancer), has long been accepted fact. However, an additional health problem that may also be associated with smoking has often been overlooked: pain.
Two recent papers indicate a strong association between smoking and pain.
The first is a
Cigarette smoking has been cited as a risk factor for a wide variety of painful conditions, including back pain,
The second paper specifically studied the most likely locations of pain among individuals who smoke. The
Those who smoked were found to be more likely to suffer chronic pain. Although the likelihood of pain was increased throughout the body, the study found that spine pain, and especially low back pain, had the strongest association with smoking. The second strongest association was between
This is an interesting and perhaps an unexpected finding. Because of the association between smoking and cardiovascular and cerebrovascular problems, it is easy to see why headaches would be fairly common among individuals who smoke. However, it might be reasonably expected that pain in the trunk and
Whether
From personal experience treating patients with chronic pain who also smoke, I know that helping them with smoking cessation attempts can be challenging. Although most patients are often well aware of the risks associated with smoking, their pain and its impact on their lives may make it more difficult for them to quit. Their pain may make them feel restricted, and their ability to participate in previously enjoyable activities is limited. Smoking is among the few such activities in which they can still indulge. They may also feel that smoking helps them cope with the pain.
Some evidence indicates that
Additionally, depression and anxiety are frequent
Ultimately, all evidence points to the importance of convincing patients with chronic pain who also smoke that tobacco is not helpful. Indeed, tobacco may be significantly exacerbating their pain and adding to their misery.
The multitude of challenges can understandably make it difficult to persuade patients with chronic pain to stop using tobacco. Unfortunately, only a
Although no single optimal treatment has yet been identified, it appears that while nicotine replacement therapy can be useful, the
Of course, this raises the important issue of who treats pain and how it is treated. (For more information on psychiatry and pain, see
For the most part, the management of chronic pain has been under the aegis of anesthesiology, followed by physiatry and neurology, with psychiatry far down the list. However, the order of these specialties would be reversed if we asked which is best able to aid in smoking cessation. One doubts that there are many anesthesiologists, physiatrists, or neurologists who have expertise in treating patients with nicotine addiction.
As a result, it is difficult for patients with chronic pain who smoke to find health care professionals qualified to treat both issues. If it appears to patients that smoking and pain are 2 separate problems that require different medical specialties to treat them, it may make it more difficult to convince them that the issues are actually entangled. Nonetheless, the evidence suggests that managing 1 issue may aid in managing the other.
Dr King is in private practice in Philadelphia.
This article was posted ahead of print on November 11, 2020, and has since been updated. -Ed
References
1. LaRowe LR, Ditre JW.
2. Smuck M, Schneider BJ, Ehsanian R, et al.
3. Ditre JW, Zale EL, LaRowe LR, et al.
4. Nakajima M, Al’Absi M.
5. Zale EL, Maisto SA, Ditre JW.
6. Ditre JW, Zale EL, LaRowe LR.
7. Hooten WM, LaRowe LR, Ditre JW, et al.
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Spike in Health Care Cyber Attacksover 4 years ago
The Oneover 4 years ago
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