The Impact of Smoking on Chronic Pain

There is a strong relationship between smoking and chronic pain. Although 22 percent of the total U.S. population smoke tobacco, almost half of all people with chronic pain smoke. Researchers believe that smoking becomes a way for chronic pain patients to manage the pain symptoms as well as the anxiety and pain that often accompany this condition.

The tragedy, of course, is that smoking often worsens the chronic pain condition in many ways. Smoking generally damages your health so that it could lead to secondary pain conditions like lower back pain or arthritis. Tobacco use also promotes pain sensitivity while simultaneously blunting the efficacy of many pain medications.

How Bad Is Smoking for Your Health?

It is almost impossible to live in 21st century America and not know that smoking is bad for you, but you may not know all of the ways that smoking negatively impacts your health. Overall, smoking is one of the worst things you can do for your health. Smoking is the leading cause of death in the U.S. with smoking linked to more than 480,000 deaths every year.

  • Lung cancer—almost 80 percent of the lung cancer deaths in the U.S. are related to smoking.
  • Loss of lung function—almost as soon as you start smoking you start to damage the airways and air sacs in the lungs.
  • Chronic obstructive pulmonary disease—COPD is a leading cause of death in the United States and progressively makes breathing more difficult.  There is no cure for this condition.
  • Coronary heart disease—CHD is the leading cause of heart attacks in the U.S. This condition involves damage to the arteries that oxygenate the heart.
  • High blood pressure—the nicotine in tobacco can cause blood vessels to constrict which will raise the blood pressure.
  • Rheumatoid arthritis—although how smoking contributes to the higher risk of rheumatoid arthritis isn’t well understood, it is believed that it damages the immune system so that it attacks the joints.
  • Lower back pain—numerous studies have shown that there is a link between smoking and low back pain. Although the exact nature of this cause and effect is still unknown, it may have to do with less blood flow to the spine.

Smoking Worsens Pain Conditions

In addition to causing many painful health problems like arthritis, COPD and low back pain, smoking can also worsen existing pain conditions. Perhaps the most problematic effect of smoking is how it negatively affects the healing process. Nicotine is a vasoconstrictor which means that it shrinks blood vessels. This reduces the delivery of oxygen and nutrients to parts of the body that are attempting to repair itself.

In addition to throttling the flow of oxygen and key nutrients, smoking also slows healing by inducing fatigue which can become chronic in nature. This fatigue is the result of blocked airways in the lungs, limiting oxygen intake. Nicotine is also believed to suppress your appetite which can lead to malnourishment and ongoing tiredness.

Finally, smoking is believed to interfere with restful sleep. Sleep loss over a long period of time can inhibit healing which can prevent the resolution of chronic pain. Long-term sleep deprivation also can make you more pain intolerant and pain sensitive.

It is also important to keep in mind that nicotine acts on the brain in many ways. First, nicotine stimulates the release of dopamine, which is a neurotransmitter that induces feelings of pleasure. This is the reason why people become addicted to smoking tobacco.

Unfortunately, this momentary pleasure response—which can in fact mask pain for a short period of time—is also a horrible incentive to damage your health. Smokers trade off a few moments of relief for much worse health problems in the long term.

Another way that smoking may worsen pain symptoms is related to emotional health. You must understand that the neurochemical pathways of pain, anxiety and depression strongly overlap, so that one of these conditions can trigger the others.

Many studies have shown that smoking can raise the risk of developing depression. While there is some debate about if depressed people start smoking or if smoking leads to depression, there is strong evidence that smokers tend to struggle with this mental condition. Regardless of the causation, depression often worsens pain intensity and episode frequency.

Finally, it is quite probable that smoking tobacco can make pain medications less effective. This is probably caused by tobacco’s effect on the liver. Tobacco smoke inhibits the function of certain enzymes in the liver that facilitate pain medications. If you are a smoker, you should tell your doctor so that they can adjust the dosage of your drugs.

Smoking Cessation in Chronic Pain Patients

There is no doubt that everyone should stop smoking as soon as possible, but it can be more difficult for chronic pain patients to quit smoking. There is reliable evidence that smoking does produce momentary pain relief so many chronic pain patients rely on smoking as a pain reliever.

Furthermore, nicotine withdrawal may induce anxiety or depression that can exacerbate pain symptoms. These issues may explain why so few chronic pain sufferers who smoke are able to quit.

If you have discussed smoking cessation with your physician and you are ready to try, here are some suggestions:

  • Pick a day and just stop. Most people who quit usually do so abruptly.
  • Nicotine replacement therapy in the form of gum, skin patches or inhalers can be quite helpful.
  • Counseling in the form of individual, group or telemedicine may provide the emotional support needed to fight off cravings.
  • Stress management can help reduce emotional triggers that push you to smoke. This may require behavior modification and lifestyle changes.
  • Hypnotherapy has helped many people curb their dependence on nicotine.
  • New medications like varenicline and bupropion can help ease nicotine withdrawal, making it easier to quit.
  • Remove all traces of tobacco from your life. In addition to eliminating cigarettes from your home, thoroughly wash all your household fabrics and your car to eliminate any tobacco odors.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA, and you should not post any of your private health information.