Associations between smoking status and bodily pain in a cross-sectional survey of UK respondents

Associations between smoking history, baseline pain interference and symptom distribution, and physical function at discharge, in individuals seeking care for musculoskeletal pain

OBJECTIVE

Study of the association between smoking and pain intensity has produced conflicting results; with less focus on pain interference. Different pain constructs could have varying associations with smoking behaviors. This study sought to investigate the association between smoking history and not only pain intensity, but also pain interference, symptom distribution and physical function.

METHODS

Smoking history (current, past, or none), pain interference (Pain, Enjoyment of Life, and General Activity scale), symptom distribution and physical function scores were extracted from medical records of patients seen in physical therapy for common sites of musculoskeletal pain (lumbar and cervical spine, knee, or hip). Generalized linear models assessed the relationship between smoking history and pain/function.

RESULTS

833 patients from an integrated healthcare system were included (mean: 57.6 years, SD=16.3; 43 % male). After controlling for several variables, current smokers had significantly higher baseline pain interference scores compared to never and former smokers (beta [B]: 0.65, 95 %CI: 0.13 to 1.18, P=.02). Smoking was not a significant predictor of symptom distribution at baseline [B: 0.17, 95 %CI -0.06 to 0.42, P=.16] or physical function scores at discharge [B: -0.03, 95 %CI: -0.08 to 0.02, P=.25].

CONCLUSION

Smokers experienced a greater impact of pain at baseline. However, symptom distribution at intake and function upon discharge were similar between all smoking groups. These findings suggest smoking cessation and abstinence may be important recommendations to help curb pain interference.

A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health

The main risk factor for atherosclerotic cardiovascular disease is smoking. Nicotine and carbon monoxide are two dangerous substances that are found in cigarette smoke. The increased heart rate can have an almost instantaneous impact on the heart and blood vessels. Smoking is well known to cause oxidative stress, endanger the lining of the arteries, and accelerate the accumulation of fatty plaque in the blood vessels. It raises the danger of sudden thrombotic events, inflammatory alterations, and low-density lipoprotein oxidation. The smoke's carbon monoxide decreases the blood's capacity to deliver oxygen, adding to the heart's stress. Notably, these risks increase when diabetes, hypertension, high cholesterol, and glucose intolerance are present. It has a detrimental effect on peripheral blood vessels, raising the possibility of thromboangiitis obliterans. Stroke risk is known to be increased by smoking. As compared to those who continue to smoke, those who give up smoking have a much longer life expectancy. Chronic cigarette smoking has been shown to affect the macrophages' ability to remove cholesterol. Abstinence from smoking enhances the function of high-density lipoproteins and cholesterol efflux, lowering the risk of plaque buildup. In this review, we present the most recent information regarding the causal relationship between smoking and cardiovascular health as well as the long-term advantages of quitting.

Predictors of abdominal pain severity in patients with constipation-prevalent irritable bowel syndrome

BACKGROUND

Symptoms of irritable bowel syndrome (IBS) have been associated to altered colonic motility and sensation. Smoking affects pain perception and is a risk factor in the development of post-infectious IBS, but its effect on abdominal pain and colonic transit remains to be elucidated in IBS.

METHODS

Forty patients with IBS-C and 28 with IBS-M were selected based on Rome IV criteria. Colonic transit time was studied and smoking habit was recorded. Presence of mild or severe abdominal pain and the prevalent pain characteristics (diffuse or localized, chronic or acute, with cramps or gradually distending) were recorded. Data were analyzed by univariate and stepwise multiple logistic regression analysis to verify the risk association between pain and all other variables.

RESULTS

IBS-C patients had a longer transit time in the right colon and scored more chronic pain than IBS-M patients. When severity of abdominal pain was used as discriminating factor, a significant number of subjects reporting severe pain were males and smokers (16/30 vs. 4/38 and 20/30 vs. 4/38, both ƿ<0.001). Multivariate analysis confirmed that smoking was an independent factor associated with severe abdominal pain (OR 14.3, CI 2-99, p=0.007). Smoking was not associated with colonic transit times and colonic transit was not associated with IBS symptoms' severity (both ƿ=N.S.).

CONCLUSIONS

Smoking was the only factor independently associated with severe abdominal pain. As smoking does not seem to affect colonic transit time, we suggest that smoking may influence visceral perception and symptoms severity in IBS patients.

Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users

BACKGROUND

Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear.

OBJECTIVES

This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors.

METHODS

Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18-64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables.

RESULTS

The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse.

CONCLUSION

Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem.

Effects of electroacupuncture on pain sensation in a rat model of hyperalgesia with nicotine dependence

Tobacco smoking is considered to be one of the main risk factors in the development of chronic pain. Long-term chronic exposure to nicotine and other forms of tobacco have been shown to be associated with an increased incidence of pain. Studies have shown that acupuncture can help smokers to reduce their desire to smoke, reduce their withdrawal symptoms, and avoid a relapse after treatment. However, little has been reported about the effects of acupuncture on pain sensitivity caused by long-term smoking. Models of hyperalgesia were established in rats exposed to nicotine for 6 weeks. After 6 weeks of continuous nicotine exposure, electroacupuncture at bilateral acupoints Zusanli (ST36) and Taichong (LR3) was performed 20 minutes per day for 6 days at a continuous wave with a frequency of 2 Hz and a stimulus intensity of 1 mA. The results revealed that electroacupuncture treatment increased the mechanical response threshold of hind paw of nicotine-dependent rats with hyperalgesia and up-regulated the protein expression of pain-related factors μ-opioid receptor, β-endorphin and glutamic acid decarboxylase 65 in the spinal cord and midbrain periaqueductal gray and the protein expression of glutamic acid decarboxylase 67 in the spinal cord. These findings suggest that electroacupuncture treatment has positive analgesic effects on pain sensitivity caused by long-term chronic nicotine exposure. One possible mechanism for the improved analgesia is that electroacupuncture increases the expression of pain-related factors in the spinal cord and midbrain periaqueductal gray. This study was approved by Institutional Animal Care and Use Committee (IACUC) of the University of Miami (#18-167) on December 12, 2018.

[Relation between tobacco smoking and pain: A narrative review of the scientific literature]

INTRODUCTION

Tobacco smoking and pain have an intimate, complex, two-way interaction. The purpose of this narrative review of the literature is to present what is currently understood about the relationship.

STATE OF KNOWLEDGE

Tobacco smoking (and the associated chronic exposure to nicotine) has been defined as a risk factor for chronic pain, involving nociceptive sensitisation. For people who smoke, pain will be both a motivational factor for tobacco consumption and a barrier to tobacco use cessation. Conversely, nicotine (acute exposure) has clearly demonstrated analgesic properties, mediated in particular by activation of nicotinic acetylcholine receptors.

PERSPECTIVES

The management of pain in people who smoke is still largely unaddressed, and further studies will be needed to develop effective strategies for tobacco use cessation in this context. Nicotine and modulators of nicotinic acetylcholine receptors represent innovative strategies for the discovery of new analgesics.

CONCLUSIONS

The effects of smoking on pain, chronic nociceptive sensitisation and acute analgesia, serve to maintain tobacco consumption via negative reinforcement. A holistic therapeutic strategy is necessary to maximise the likelihood of successful smoking cessation.