Smokers More Likely to Report Chronic Pain than Nonsmokers

Smoking has been connected to several serious health conditions such as cancer, lung disease and heart disease. Recently, medical researchers have begun to look into how smoking may affect a person's experience of pain.

A recent study conducted at the University of Kentucky School of Public Health joins ranks with many other health studies looking into why smokers are more likely to report pain – particularly musculoskeletal pain – than their nonsmoking counterparts. The study took a survey of 6,000 women via the Kentucky Women's Health Registry. The researchers divided the survey respondents according to age, smoking habit and number of cigarettes smoked daily.

What the University of Kentucky team found was that smokers reported more instances of chronic pain than did nonsmoking women. This study also revealed a dose-dependent relationship between smoking and pain. Those who were heavy smokers (more than one pack per day) tended to be those who struggled most with chronic pain.

Theories on the Smoking-Pain Connection

The University of Kentucky has not been alone in researching this smoking-pain link. The Mayo Clinic and other medical research teams around the world are investigating the phenomenon. It is a phenomenon because it represents a puzzling paradox. On one hand nicotine is known to have analgesic properties. On the other hand, smoking increases experiences of pain. How to reconcile those truths has produced a number of theories:

Theory #1: Coughing which results from smoking produces abdominal pressure and back pain. Perhaps nicotine sensitizes pain receptors.

Theory #2: Smoking produces changes in the neuroendocrine system. In a healthy person, the stress of pain triggers the hypothalamic-pituitary-adrenal axis to work to blunt pain perception, but in smokers, the HPA is down-regulated.

Theory #3: Smoking speeds up degenerative processes such as those associated with osteoporosis and lumbar disc disease. It also inhibits bone's ability to heal. Smokers would then be predisposed to injury, slow to heal and at an increased risk for pain.

Theory #4: Smokers suffer from disproportionately high instances of mood disorders and depression is linked biologically to experiences of pain. Therefore, smokers are more likely to be depressed and at greater risk for chronic pain.

Not surprisingly, smokers statistically tend to consume more prescription opioids and higher doses of the drugs than nonsmoking patients.

Implications for Chronic Pain Treatment

One positive to come from the research is the possibility of using smoking cessation techniques in the treatment of chronic pain patients. One study demonstrated that feeling pain increased a smoker or former smoker's desire to smoke. Women who suffer from fibromyalgia, for example, who may feel the temptation to smoke, might instead be led to find pain mitigation through smoking cessation.

Even though it cannot be fully explained, it is clear to health professionals and researchers that there is a connection between smoking and the likelihood that a person will experience chronic pain. Smokers report more pain and more debilitating pain than those who do not smoke. For those who treat chronic pain patients, employing smoking cessation techniques with those patients who smoke could be a way to reduce opioid dependence.