Smoking, Depression, and Chronic Pain

If you need one more reason to quit smoking, add this to your list: smokers are more likely to have both acute and chronic pain. In fact, even after they quit, former smokers tend to have more pain than those who have never smoked.

Researchers have long known about the association between smoking and chronic pain. However, there is an important question to consider: is smoking the cause of the pain or do those who are in pain turn to smoking to self-medicate?

Nicotine has been shown to have short term anti-nociceptive effects - that is, it tends to make people less sensitive to painful stimuli. (This may be more true in men than in women.) However, over time, smoking makes one more prone to both acute and chronic pain. In addition, smoking is associated with increased use of opiod drugs. Considering the current problems in the U.S. with opioid addiction and the alarming increase in deaths from overdose, addressing the problems of smoking and chronic pain might be one more route to decrease opioid dependence.

The association between smoking and chronic pain are further complicated by depression. Symptoms of depression are common among smokers with chronic pain. Elevated levels of depression may contribute to elevated levels of pain. It's complex. Which comes first? The pain? The smoking? The depression? Are there particular physiological factors responsible for these different conditions occurring together? 

Paul Ingraham, author of the website, has written a well-researched article on smoking and chronic pain. He quotes one pain management doctor, referring to the high failure rate of treating smokers with chronic pain, as saying that smokers are so difficult to treat, he will not accept them as patients. This is discouraging news for smokers.

So, what is to be done? Obviously, if one is a smoker and suffering from chronic pain, quitting smoking needs to be a priority if one wants to have success in reducing pain. Treating depression, when it is present, may be equally important, considering the association between smoking, depression, and pain. Use of smokeless nicotine, such as patches, gum, or e-cigarettes, may not be helpful in treating chronic pain since nicotine itself appears to be a culprit. In reviewing studies on smoking cessation, it seems that a multilevel approach combining medication, social support, and behavioral support, offers the best chance for success. One systematic review found that quitting smoking  improved symptoms of anxiety and depression equal to the effect of being treated with an antidepressant. The cause vs. effect question continues! However, it seems there is no question that quitting smoking can improve overall health.

Might massage help?

It has been said that quitting smoking is more difficult than quitting heroin. In his book The Compass of Pleasure, neuroscientist David Linden describes what is currently known about the brain and addiction. In an interview with Terry Gross on NPR, Linden claims that cigarettes are one of the most addictive substances known and that eighty percent of those who try cigarettes become addicted.

It would be irresponsible to make the claim that massage could help solve the difficult, interrelated problems of smoking, depression, and chronic pain. However, considering some things we know about massage, it's possible that massage might assist some individuals in their efforts. We know that massage has been shown to relieve symptoms of anxiety and depression. Although the research is not robust, many people find massage can provide at least some temporary relief from chronic pain. One very small study showed that self-massage helped reduce cravings among smokers. Another small study suggested that massage might reduce symptoms of alcohol withdrawal. Considering the toll that smoking takes on overall health, it would be an interesting area of future study to see if massage could improve success rates with smoking cessation. Obviously, massage should not be used as a substitute for established treatments already found to be effective but it might be possible that, combined with other proven therapies, massage could give a bit of an assist to someone struggling with quitting smoking. Maybe. If nothing else, a person might use massage as a reward for abstaining from cigarettes.

There's no question that if you are a smoker and have chronic pain, you need to quit smoking if you want to try to reduce your pain. It's not easy. Ask your doctor for help. Get some social support. And if you want to use massage to help you ease through this transition, at the very least it may provide you with a pleasant distraction that can help you remember what it's like to feel good in your body.

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Depression as a risk factor for onset of an episode of troublesome neck and low back pain Full text Pain 2004

The Effects of Depression and Smoking on Pain Severity and Opioid Use in Patients with Chronic Pain Full text Pain 2011

Smoking Status and Pain Intensity Among OEF/OIF/OND Veterans Pain Medicine 2015

Understanding the Complex Relationship Between Smoking and Increased Pain Article American Society of Anesthesiologists 2010