Janice Milliman, Quit Coach, Service Delivery:

Many tobacco users we talk with identify chronic pain as a significant barrier to quitting. Chronic pain can have many causes, such as rheumatoid arthritis, fibromyalgia, degenerative disk disease or "just" an old back injury. For chronic pain sufferers, smoking is often associated with pain relief, but it actually is counterproductive and worsens pain. Pain and smoking feed into each other and become so enmeshed it can be difficult to separate the two and create an effective quit plan.

The Effect of Chronic Pain on Smoking Behavior

With an inflammatory condition and chronic pain myself I can relate to those who are concerned about their quit resulting in more pain. It is very likely that in previous quit attempts the result was just that -- whether perceived or actual, they felt more pain. If that experience occurred multiple times over, it's natural that one would be hesitant about making another quit attempt. Even though quitting would help other health conditions, the thought of pain becoming worse just doesn't seem worth the risk.

Symptoms of depression are quite common in people with chronic pain. Depression compounds the challenge of quitting because many people also associate smoking with emotional relief. When nicotine reaches the brain it stimulates the pleasure center, giving a temporary sense of relief from pain, depression and other emotional symptoms such as anxiety.

Researchers found that when deprived of nicotine, smokers report pain symptoms earlier and have a lower pain threshold. Previous studies concluded that nicotine does have some pain relief benefits. Nicotine causes a rapid release of adrenaline, a hormone that affects the sympathetic nervous system, and blunts pain perception. This process occurs naturally in non-smokers as well, but instead of nicotine, the adrenaline release is stimulated by the normal physiologic pain response. Even though cigarettes contain nicotine, smokers experience an altered regulation of the sympathetic nervous system which results in an increased perception of pain. Nicotine provides temporary and fleeting relief, but the tobacco worsens pain in the long run.

The Effect of Smoking on Chronic Pain

Smoking has numerous negative effects on the body resulting in greater discomfort in chronic pain sufferers. Smokers with fibromyalgia reported greater pain intensity than non-smokers with the same condition. According to the Mayo Clinic, people with fibromyalgia experience widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues, and is believed to affect how the brain processes pain signals.
Poor circulation, commonly caused by tobacco use, can lead to chronic pain. Diabetic patients, for example, can experience a condition called diabetic neuropathy where nerve damage in the legs and feet can cause significant pain. Tobacco use makes it harder for the body to regulate blood sugar which can lead to greater complications for diabetics.

In general, smoking inhibits the body's ability to heal from injury or surgery. Information from to two separate studies (Young et al., 2008; Ogawa et al., 2005) highlight the specific affects smoking has on bone health and healing. This can mean a painful quality of life for current or former smokers whose spinal disks, for example, heal poorly after surgery.

In most cases there is no single treatment or cure for chronic pain. Symptom management can be achieved through the use of appropriate medications and changes in activity level and lifestyle. As tempting as it may be to utilize a "quick fix" for pain management, that's not necessarily the best long term approach. In the case of smoking, the real or perceived pain relief from one cigarette is minimal compared to the exacerbation of pain and damage done to the body. Smokers with chronic pain will benefit from individualized quit plans which address adequate nicotine withdrawal relief, education on the relationship between smoking and pain symptoms, and coaching for alternative behavioral and emotional strategies for coping with pain.