Cause and Effect

Cause and Effect: Smoking and Pain

       Rapid-fire clinical pearls on emerging topics in pain medicine were presented to session attendees by some of the field’s seasoned veterans. As part of that discussion, W. Michael Hooten, MD, associate professor of anesthesiology in the Departments of Anesthesiology, Pain Medicine, Psychiatry, and Psychology at the Pain Rehabilitation Center, Mayo Clinic, in Rochester, Minnesota, posed very poignant questions to the audience regarding smoking and chronic pain.

“At the end of the day, it’s harder for opioid patients to quit smoking,” said Dr. Hooten. “But by answering three major questions, we’re hoping we’ll find out why.”

      First off, does smoking cause pain? Nicotine does have analgesic or nociceptive properties, and smoke from nicotine and tobacco can have an effect on analgesic medications. Examining the results of a study Dr. Hooten conducted in 2011, which explored the effects of depression and smoking on pain severity in opioid patients, he determined that, in terms of a causal link, smoking does not cause pain. Though depression mediated the relationship in the study, smoking is still considered to be a weak risk factor for chronic pain.  

     Secondly, do smokers experience greater pain than non-smokers? In his clinical experience, Dr. Hooten has seen smokers report a little bit more pain severity on a consistent basis. However, depression also plays a factor, often mediating that relationship.

     Lastly do smokers use more opioids to manage their pain than non-smokers? “In my clinical practice, smokers consume more opioids, and this observation is predominantly driven by men. There’s a predominant sex effect. Depression, though, is not a factor.”