The Effect of Smoking Cessation on Acute Pain: A Systematic Review

Abstract

Smoking is a known risk factor for developing various pain-related disorders. However, acute pain often triggers the craving for cigarette consumption, resulting in a positive feedback mechanism. In addition, there is evidence of decreased pain tolerance during the early stages of abstinence. Therefore, in this study, we aimed to investigate whether a period of decreased pain tolerance and increased pain intensity occurs during smoking cessation. A systematic literature search was conducted through PubMed and Web of Science databases for controlled studies investigating the influence of smoking cessation on acute (defined as pain presentation of \ 3 months) and postoperative pain. The outcomes of interest included pain perception threshold, pain tolerance, pain intensity, and postoperative opioid requirements. The search strategy yielded 1478 studies, of which 13 clinical studies met our inclusion criteria. The included studies collectively represented data from 1721 participants from four countries. Of these, 43.3% of the included individuals were females. The mean age of the included subjects was 44.2 ± 8.2 years. The duration of smoking cessation varied considerably. The shortest duration was 2 h; others investigated the effect after more than 1 month of smoking cessation. Smokers had a history of 14.6 ± 9.9 years of nicotine abuse. The mean number of daily smoked cigarettes was 17.5 ± 10.3. Most studies examined in this systematic review show a negative influence of smoking cessation on acute pain. However, the affected pain modalities, the duration of the altered pain perception, and whether male and female smokers are equally affected could not be ascertained due to high heterogeneity and few available studies.

The Dose-Response Relationship between Opioid Agonist Therapy and Alterations in Pain Pathways in Patients with Opioid Use Disorders: A Cross-Sectional Study

“…Likewise, we may have not included other potential confounding variables, including information regarding the co-occurrence of various non-opioid substance use disorders. For smoking, for example, an interdependency with pain perception is frequently reported [ 47 ]. Assessing data on addictive behavior is however a methodological challenge, with a great chance of misinformation [ 48 ].…”

Health and economic burden of low back pain and rheumatoid arthritis attributable to smoking in 192 countries and territories in 2019

“…Several studies have revealed the mechanisms by which smoking contributes to LBP and RA. Smoking reduces blood supply to the intervertebral discs, resulting in degenerative changes and LBP [7].…”

“…Several studies have revealed the mechanisms by which smoking contributes to LBP and RA. Smoking reduces blood supply to the intervertebral discs, resulting in degenerative changes and LBP [7]. Moreover, smoking has been shown to elevate the levels of proinflammatory cytokines, which transmit signals to the nervous system and amplify pain [8].…”

Sex differences in the association between smoking and central sensitization: A cross-sectional study

“…Several reports present the smoking rate among pain patients to exceed that of people who do not smoke 2 . Furthermore, individuals experiencing pain, such as people who smoke, tend to smoke more frequently than their pain-free counterparts 3 . The pain leads to a craving for smoking, which has a temporary analgesic effect 4 .…”