The Soft Link Between Smoking and Pain

15 Jul

So, if you’re like me, you’ve used smoking to cope with your pain from time to time. Or rather, you’ve justified smoking because it seems like a great coping mechanism. I have sat around and chain smoked before when my pain has been the worst. Do I think that it helps? Of course not! I do think however that it helps to act as a distraction at times. A recent “study” has been published that states that we are better off quitting then coping using this method. See below for the full article.

Interventional Pain Medicine
ISSUE: JULY 2012 | VOLUME: 10:07
Smoking Cigarettes a Poor Coping Strategy For Chronic Pain

by George Ochoa

Among patients with chronic pain, smokers who reported using cigarettes to cope had worse pain-related outcomes than either nonsmokers or smokers who denied using smoking to manage their pain, according to a new study in the Journal of Pain (2012;13:285-292).

“These findings may be contrary to expectations for some people,” two study authors, Alexander Patterson, PsyD, affiliated with the National Center for Telehealth and Technology, Tacoma, Wash., and Benjamin Morasco, PhD, staff psychologist, Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, and assistant professor, Department of Psychiatry, Oregon Health & Science University, Portland, said in an email. “There are a number of patients who, in the context of routine clinical care, mention that smoking cigarettes can be helpful for providing distraction and reducing the severity of pain. The results from this study suggest that this coping strategy is associated with poorer pain-related outcomes.”

In this cross-sectional study, Drs. Patterson and Morasco recruited 151 veterans from a VA medical center. Most were male (92.1%), white (74.8%) and middle-aged (median, 54.2 years). Current smoking status was assessed through a single self-report question (yes/no), and smoking to cope with pain was assessed through a yes/no response to the question, “Have you ever smoked cigarettes to help cope with pain?” Of current smokers (n=79), 40 denied using cigarettes to cope with pain and 39 reported using cigarettes to cope with pain; the remaining 72 patients were nonsmokers. All had pain diagnoses, most commonly chronic neck or joint pain, chronic low back pain and rheumatism/arthritis.

Applying pain measures (the Multidimensional Pain Inventory, the Pain Anxiety Symptoms Scale and the Chronic Pain Coping Inventory), the researchers found that the use of smoking cigarettes as a coping strategy was associated with worse pain-related outcomes, including greater pain intensity, poorer pain-related functioning and more fear of pain. Smokers who denied smoking cigarettes as a coping strategy had similar pain-related outcomes as nonsmokers. After controlling for the effects of demographic and clinical factors, smoking cigarettes as a coping strategy for pain was positively associated with pain intensity (P=0.04), pain interference (P=0.005) and fear of pain (P=0.04).

“This is similar to a finding from our previous qualitative study (Pain Prac 2011;11:552-563) where patients with chronic pain reported that smoking was an important way to distract attention and focus away from pain,” said W. Michael Hooten, MD, associate professor of anesthesiology, Mayo Clinic, Rochester, Minn., who was not involved in the current study. Dr. Hooten noted certain limitations of the study, such as the small sample size, some P values just under the level of statistical significance (e.g., P=0.04 for pain intensity), and potential lack of generalizability to the population at large.

The Pain–Smoking Link

Many questions remain about smoking and chronic pain, according to experts. “The most important finding we still need to explain is how smoking can increase the risk for low back pain or pain in general,” Fahad Alkherayf, MD, FRCSC, neurosurgeon and spine surgeon, Ottawa Hospital, University of Ottawa, Ontario, Canada, said in an email. “The exact mechanism for this finding is still unclear.”

“It may be that people who smoke have impaired healing that results in chronic pain,” David M. Mannino, MD, professor, director of graduate studies, master of science in clinical research design, and director, Pulmonary Epidemiology Research Laboratory, Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, suggested in an email. ”It may also be that people who develop chronic pain syndromes start to smoke (or can’t stop smoking) to ‘self-medicate.’”

One view about smoking and pain is that they operate in a positive feedback loop. “There is evidence that tobacco smoking may be a risk factor for the development and exacerbation of pain (effects of smoking on pain) and that pain may serve to motivate smoking (effects of pain on smoking),” said Joseph W. Ditre, PhD, assistant professor, Department of Psychology, Texas A&M University, College Station, an originator of the pain–smoking positive feedback loop hypothesis. The end result of the reciprocal relation between pain and smoking, said Dr. Ditre in an email, is “increased pain and the maintenance of tobacco dependence.”

“More smoking leads to more nicotine exposure leads to desensitization of nicotinic receptors and dysfunction of native pain inhibitory systems and more pain sensitivity, which then leads to stress and more smoking,” said Pamela Flood, MD, professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, in describing the smoking and pain loop. Depression, she said, also interacts with smoking and chronic pain, “likely [in] a feed-forward loop. You might throw in alcohol as well, but the mechanisms are less clear.”

When asked what could explain the difference in pain between the two groups of smokers, Drs. Patterson and Morasco said, “It is possible that smoking cigarettes to cope with pain is a form of behavioral avoidance, similar to other passive coping strategies that have been shown to worsen pain-related outcomes among individuals with chronic pain (e.g., sleeping, decreased movement, some medications, etc.).” They added, “It also is possible that individuals who endorsed smoking to cope with pain had greater baseline pain awareness, which has been shown to be related to poorer pain-related outcome.”

Although the current study found smokers who denied smoking cigarettes to cope had similar pain-related outcomes as nonsmokers, Drs. Patterson and Morasco said they would still counsel such smokers to quit because of the health problems associated with the habit. Additionally, patients who do use cigarettes to cope with chronic pain “may benefit from interventions focused on reducing the use of cigarettes as a coping mechanism and increasing the use of alternative, and more adaptive, coping strategies.”


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