Effects of Smoking on Neuropathic Pain in Two People With Spinal Cord Injury

Abstract

Background/Objective: To describe an apparent relationship between smoking and the neuropathic pain experience in people with spinal cord injury (SCI).Method: Case Reports.Participants/Methods: Two individuals treated at a rehabilitation center. The first was a 38-year-old white man with a T12 SCI, American Spinal Injury Association (ASIA) impairment scale (AIS) A, secondary to motor vehicle crash. Duration of injury was 14 years. He reported burning pain in his legs, and has smoked ½ pack per day for the last 15 years. The second was a 55-year-old African American man with a T6 SCI, AIS A, secondary to gunshot wound. Duration of injury was 22 years. He was a 40-year ½ to 1 pack per day smoker, who, after injury, consistently experienced burning, radicular pain, rated 7/10, around the level of the injury. Summary:The first subject rated his pain as 4/10 when not smoking and 7/10 when smoking. The pain subsided 30 minutes after smoking was discontinued. He noted an immediate increase in neuropathic pain when smoking. The second subject quit smoking for 1 month and immediately noted that the pain disappeared, rating it 0/10. After he resumed smoking, his radicular pain was 8.5/10 in the morning and 5/10 in afternoon. Conclusions:No similar reports have been published, based on a MEDLINE search. Nicotinic receptors have been implicated in pain perception. It is unclear to what extent these 2 cases generalize to the SCI population. We plan to explore this via survey and experimental research. Smoking cessation may have a dual benefit of increased health and decreased neuropathic pain.J Spinal Cord Med. 2005;28:330-332

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

“…Consequently, smoking or tobacco use would determine the analgesic (or enhanced nociceptive) effect. These findings, in conjunction with prior clinical observations 11,12,16 and neurobiological evidence implicating possible mechanisms of pain in the context of nicotine use, suggest a potentially fruitful area of future research in both human and animal studies. In addition, the results found among smokers could lead to targeted interventions based on mechanisms underlying the nicotine-pain connection.…”

Tobacco dependence in surgical patients

“…Nicotine can be a powerful analgesic in animal models and also has shown efficacy when systemically administered to relieve postoperative pain [38,39 ]. A case report of two smokers with neuropathic pain who dramatically improved after smoking cessation provides more hints that smoking may significantly affect the management of chronic pain, but much more study is required [40].…”

Smoking behavior and delivery of evidence-based care for veterans with spinal cord injuries and disorders

“…In a recent article, Richards describes the apparent relationship between smoking and neuropathic pain in two persons with SCI. 19 Both patients reported increased pain when they smoked. This report suggests that the relationship between pain and smoking should be more carefully examined in this population.…”