Interventions Targeting Smoking Cessation for Patients With Chronic Pain: An Evidence Synthesis

Saragiotto, Bruno Tirotti; Kamper, Steven J.; Hodder, Rebecca K; Silva, Priscilla V; Wolfenden, Luke; Lee, Hopin; Oliveira, Vinícius Cunha; Robson, Emma; Wiggers, John; Williams, Christopher M

doi:10.1093/ntr/nty255

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Smokers experience more severe musculoskeletal and other chronic pain than nonsmokers because smoking causes tobacco-related diseases; damages musculoskeletal and other systems, leading for instance to osteoporosis, lumbar disc disease, and delayed bone and wound healing; and induces neuronal changes in pain pathways [ 11 ]. However, smoking cessation was not identified as an independent predictor of pain symptom changes in many studies [ 128 , 129 ]. Chronic pain patients who smoke often fail to experience pain relief when they stop smoking.…”

Section: Clinical Questionsmentioning

confidence: 99%

Consensus statement on smoking cessation in patients with pain

et al. 2022

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Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.

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Section: Clinical Questionsmentioning

confidence: 99%

Consensus statement on smoking cessation in patients with pain

et al. 2022

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“…Indeed, ongoing smoking becomes a risk factor for the onset or exacerbation of back pain, sciatica, arthritis, fibromyalgia, and chronic headache. [37][38][39][40][41] Nicotine (or perhaps another component in tobacco smoke) may sensitize pain receptors, decrease pain tolerance, and increase pain awareness. 42 Prospective cohort studies of adolescents bear this out, demonstrating that smoking early in life causes chronic back pain leading to related hospitalizations, initial opioid use, and potential opioid addiction persisting into adulthood.…”

Section: Biological Underpinningsmentioning

confidence: 99%

“…[43][44][45] Logically, it would follow that smoking cessation might then be a treatment for chronic pain, 34,46 but randomized controlled trials have not substantiated this hypothesis. 41 Continued research is needed to further elucidate the complex relationship between smoking and pain.…”

Section: Biological Underpinningsmentioning

confidence: 99%

Nicotine and Opioids: a Call for Co-treatment as the Standard of Care

Morris

Garver‐Apgar

2020

J Behav Health Serv Res

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The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.

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“…There is evidence that smokers with pain (vs. no pain) are more likely to seek out pharmacotherapy for cessation (Zale & Ditre, 2014), and it has been suggested that these individuals may benefit from high-dose or combination nicotine replacement therapy (Hatsukami et al, 2007; Mills et al, 2012; Zale & Ditre, 2014). Behavioral cessation interventions have also been successfully administered to smokers with chronic pain (Saragiotto et al, 2018), and integrated treatments for pain and smoking have been shown to increase knowledge of pain-smoking interrelations, and confidence/intention to quit smoking (Ditre, LaRowe, Vanable, De Vita, & Zvolensky, 2019; Hooten, LaRowe, Zale, Ditre, & Warner, 2019).…”

Section: Discussionmentioning

confidence: 99%

Pain characteristics and nicotine deprivation as predictors of performance during a laboratory paradigm of smoking cessation.

Powers¹,

LaRowe²,

Heckman³

et al. 2020

Psychology of Addictive Behaviors

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Although smokers with co-occurring pain report expectations for experiencing greater nicotine withdrawal and difficulty quitting, limited work has examined the role of pain in cessation-related outcomes. The goal of this study was to examine clinically relevant pain characteristics (pain persistence, pain intensity, pain-related disability) as predictors of withdrawal and smoking lapse/relapse outcomes using a laboratory paradigm of cessation. Participants (N = 120 daily cigarette smokers; 48% male; Mage = 36.17, SD = 12.16; MCigarettes Per Day = 20.51, SD = 6.99) were randomized to either nondeprived or 12-hr nicotine deprivation conditions prior to an experimental study visit. Upon arrival to the laboratory, participants completed measures of pain characteristics and nicotine withdrawal symptoms. Primary outcomes included nicotine withdrawal scores and analogues of smoking lapse (latency to initiating smoking) and relapse (number of cigarettes smoked). We hypothesized that smokers with greater pain persistence, pain intensity, and pain-related disability would endorse more severe nicotine withdrawal and greater lapse/relapse behavior, and that these positive associations would be stronger among those who were nicotine deprived. Results indicated that, above and beyond the effect of nicotine deprivation, persistent pain predicted more severe nicotine withdrawal, and that greater pain-related disability predicted quicker latency to lapse during the laboratory paradigm. Contrary to expectation, nicotine deprivation did not moderate effects of pain characteristics on withdrawal or lapse/relapse outcomes. Clinical implications include that different pain processes may influence different cessation outcomes, and that smokers in pain may benefit from the provision of pharmacological aids to better control withdrawal symptoms.

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Interventions Targeting Smoking Cessation for Patients With Chronic Pain: An Evidence Synthesis

Cited by 9 publications

References 22 publications

Consensus statement on smoking cessation in patients with pain

Consensus statement on smoking cessation in patients with pain

Nicotine and Opioids: a Call for Co-treatment as the Standard of Care

Pain characteristics and nicotine deprivation as predictors of performance during a laboratory paradigm of smoking cessation.

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