Smoking and chronic pain

Do you smoke to deal with your chronic pain? Do you wish you could quit but feel like it’s too hard, your pain’s too much, you need to smoke to deal with the stress? You’re not alone!

Smoking must be the hardest addiction to quit. Each time you inhale, it takes nanoseconds for the nicotine to hit the nicotine receptors in the brain, and those receptors multiple in number when you first start smoking – and never reduce, so they’re crying out for nicotine to satisfy them.

There are some good things about smoking, or you wouldn’t be doing it. Some people say it’s calming – taking some time out, giving yourself a brain break, catching up with other people who are also smoking. Some others say it’s dependable, reliable, it won’t let you down, you know the effect and it’s almost like a friend. There are sure to be other good things from your perspective.

Then there are the not so good things about smoking – you already probably know the main ones, like the expense, the health effects on lungs, skin and fingers, the cough. What you might not know are some of the relationships between smoking and your pain.

There is a greater percentage of people who have chronic pain and are smokers – around 42% according to some studies. In the general population, at least in New Zealand, the percentage of smokers is around 16% and dropping. People who have problems with mood and anxiety are more likely to smoke, and if you have chronic pain you’re more likely to have a problem with mood or anxiety as well. People who have pain and smoke are more likely to live with, or around people who also smoke, which makes it pretty hard to quit. If you’ve had to stop working because of your pain, you might be more likely to smoke as well.

If you smoke, you’re more at risk of developing chronic low back pain, and in particular, you’re more likely to have degenerated discs, but these may repair themselves if you stop.

If you have rheumatoid arthritis, smoking is “the best established environmental risk factor for developing RA” (Sugiyama et al., 2010), and smoking is associated with greater RA disease severity. There are some disease mechanisms directly affected by smoking such as immunoglobulin M–RF (IgM–RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and shared epitopes (Christensen, Lindegaard, & Junker, 2008).

Cigarette smoking is associated with headache – smokers in one study were found to report headaches 1.5 times more frequently than non-smokers (Aamodt et al., 2006), and have headaches more often during a month (14 days per month). This is thought to occur because various neuroreceptors in the brain become sensitised to tobacco, and increase the amount of information they allow through, while there are changes in nitric oxide, carbon monoxide and decreased monoamine oxidase activity as well as reduced effectiveness of headache medications because they are metabolised more quickly in the presence of tobacco smoke.

Why do people smoke more when they’re in pain?

There’s very clear evidence that when people are in more pain, they smoke more and exercise less.  The reasons for this include pain being unpleasant, creating a feeling of unhappiness – smokers use cigarettes to help deal with stress, and negative mood, and so it’s not surprising that people reach for a cigarette when their pain is high. What you might not know is that this could happen because you expect cigarettes to help, it could be because it temporarily distracts you, it might help relieve boredom, calm your irritation down, and help you feel like you’re taking control in a situation where you don’t have much control.

What you may not know is that because smoking is associated with relieving negative mood, people may learn to associate having body symptoms like heart rate changes, irritability and difficulty concentrating, things that can occur with pain, with being relieved by smoking – so smoking reduces these feelings, and it becomes experienced as very pleasurable.

What can help you quit?

When your pain is high, many people are more aware that their smoking isn’t a useful way to cope, but at the same time find it’s much harder to feel confident that you CAN quit. So people are often thinking about quitting, but don’t quite get around to it because it seems way too hard, especially when you’re dealing with all these stressors.

Like making any change, motivation to quit smoking must come from your own reasons, not the reasons other people give you. So you’ve probably already worked out why it might be good to quit. To build your confidence that you CAN quit isn’t quite as easy – but let’s see what you already know about quitting.

If you’ve quit before, you know you can do it. You know the times when it’s most difficult. You know the triggers. You know what worked, but more importantly, you know when it didn’t work – so you can plan around these times.

If you quit without help before – how amazing! You’ve got real grit and determination. It’s hard to quit without help, and that’s why this time around, you might want to get some extra support for yourself, it’ll increase the likelihood that you CAN quit.

Things like nicotine replacement (patches, gum, electronic cigarettes) can be gradually phased away, so the cravings are less. Using a quit buddy or joining Quitline (in New Zealand – your country will have other options) helps a LOT. Knowing that someone is there to talk with you, be supportive when it’s tough can really make the job easier.

Keeping the positive reasons for quitting up front and visible also helps – writing down why you want to stop, and all the benefits of quitting and keeping these where you can see them can remind you of your own reasons for quitting.

Getting rid of all the smoking bits and pieces, those lighters, the half-empty pack, the old ash trays, staying away from places and people you associate with lighting up: these are all practical steps you can take.

Learning some additional coping skills to deal with stress like walking, relaxation, listening to music, problem solving – these are also good ways to help you through the process.

Quitting smoking is often a long process, and people often quit many times – but people DO quit successfully, and live better for it – you might even find, as one study did, that pain intensity reduces as well (Behrend, Prasarn, Coyne, Horodyski, Wright & Rechtine, 2012).

Aamodt, A. H., Stovner, L. J., Hagen, K., Brathen, G., & Zwart, J. (2006). Headache prevalence related to smoking and alcohol use. The HeadHUNT Study. European Journal of Neurology, 13, 1233–1238. doi:10.1111/j.1468-1331.2006.01492.x

BEHREND, C., PRASARN, M., COYNE, E., HORODYSKI, M., WRIGHT, J. & RECHTINE, G. R. 2012. Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care. Journal of Bone & Joint Surgery – American Volume, 94, 2161-6.

DITRE, J. W., BRANDON, T. H., ZALE, E. L. & MEAGHER, M. M. 2011. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychological Bulletin, 137, 1065-93.

Sugiyama, D., Nishimura, K., Tamaki, K., Tsuji, G., Nakazawa, T., Morinobu, A., & Kumagai, S. (2010). Impact of smoking as a risk factor for developing rheumatoid arthritis: A meta-analysis of observational studies. Annals of the Rheumatic Diseases, 69, 70 – 81. doi:10.1136/ard.2008.096487

 

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