Effects of Nicotine on Spinal Cord Injury Pain: A Randomized, Double-Blind, Placebo Controlled Crossover Trial

Abstract

persons with SCI, similar findings have emerged, as results from one longitudinal study found that those who were smokers with SCI reported more musculoskeletal pain across time. 15Case reports also suggest that smoking affects a particular subtype of SCI-related pain: neuropathic pain. Richards and colleagues 16 noted 2 individuals with SCI who experienced worsening of neuropathic pain from smoking. Two men with long-standing paraplegia were habitual smokers of ½ to 1 pack of cigarettes per day. When required to stop smoking prior to a surgical procedure to repair nonhealing pressure sores, the men complied and subsequently reported a marked reduction in pain levels. After discharge, both men resumed smoking and reported an immediate return of the pain to the level experienced prior to their abstinence.Although evidence to date suggests a relationship between smoking status and pain exacerbation following SCI, available data are descriptive/ correlational and therefore cannot be used to infer causal relationships. Moreover, SCI-related pain Background: One factor affecting spinal cord injury (SCI)-related pain may be nicotine. Case reports have described a worsening of neuropathic pain from smoking and relief from abstinence. Neurobiological correlates also implicate the potential effect of nicotine on SCI-related pain. Method: The current study employed a randomized, placebo-controlled crossover design to examine the effect of nicotine exposure on subtypes of SCI-related pain among smokers and nonsmokers. Results: Whereas nonsmokers with SCI showed a reduction in mixed forms of pain following nicotine exposure, smokers with SCI showed a converse increase in pain with regard to both mixed and neuropathic forms of pain. The exacerbation of pain in chronic nicotine or tobacco users may not only elucidate possible pain mechanisms but may also be of use in smoking cessation counseling among those with SCI.

Neuropathic Pain Related with Spinal Disorders: A Systematic Review

“…Fig. 1 presents a flowchart of the selection process, and the results are summarized in Table 2 [ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 ].…”

“…Lidocaine exhibited significant analgesic effects on spontaneous pain for the first 45-minute post-injection; however, there was no difference when compared with placebo [ 43 44 ]. One interesting RCT demonstrated the usefulness of nicotine in patients with spinal cord injuries [ 45 ]. Following nicotine exposure, non-smokers showed a reduction in mixed forms of pain; conversely, smokers showed an increase in both mixed and neuropathic forms of pain, indicating the need of smoking cessation counseling among smokers with a spinal cord injury [ 45 ].…”

“…One interesting RCT demonstrated the usefulness of nicotine in patients with spinal cord injuries [ 45 ]. Following nicotine exposure, non-smokers showed a reduction in mixed forms of pain; conversely, smokers showed an increase in both mixed and neuropathic forms of pain, indicating the need of smoking cessation counseling among smokers with a spinal cord injury [ 45 ]. However, the small population and the results in just one article need for attention to interpretation.…”

Development of a pain self-management intervention framework for people with spinal cord injury

“…77,78 The smoking is found to have both causal and reciprocal effects on pain in the general population 80 and worsening pain in PWSCI. 81 Increased leisure-time physical activity as well as physical activity targeted at weight loss is associated with decreased pain levels and improved health satisfaction in PWSCI. 82,83,84 Lifestyle changes can be achieved by using selfmanagement programmes that focus on behaviour change.…”

Pain experiences among a population‐based cohort of current, former, and never regular smokers with lung and colorectal cancer

“…9 One explanation for the smoking-pain connection is that, in the short term, smoking may elicit acute analgesic effects 10,11 ; however, coupled with nicotine depletion, smoking may actually exacerbate pain in the long term. 12 This is particularly problematic, given that smokers may be less motivated to quit because they rely on smoking to cope with pain and emotional distress. 13,14 As such, smokers with pain may need additional skills to manage pain while quitting smoking.…”