Newswise — An estimated one in five Americans smoke cigarettes, and at least one in 10 nonsmokers are exposed to second-hand smoke at home. A new review published in the October 2010 issue of Anesthesiology examines how exposure to nicotine and other chemicals in cigarette smoke has an impact on pain for these individuals.

According to research author David O. Warner, M.D., from Mayo Clinic College of Medicine in Rochester, Minn., individuals exposed to nicotine are at an increased risk to develop back pain and other pain-related problems. Smokers also tend to be more sensitive to painful stimuli.

“Nicotine interacts with receptors in the nervous system, which are involved in numerous processes, including arousal, sleep, anxiety, cognition and pain,” explained Dr. Warner. “Individuals who smoke also are more prone to depression. It is important to understand the complex relationship between smoking and pain so clinicians can better treat smokers with painful conditions.”

Findings from the ReviewThe researchers analyzed more than 200 studies to better understand how exposure to nicotine and cigarette smoke impacts acute and chronic pain conditions. Data analyzed in the review showed smokers in pain treatment programs more frequently reported pain and greater functional impairment compared with nonsmokers.1,2,3,4 Smokers also were less likely to be employed compared with nonsmokers who were being treated for low back pain.5

The review investigated clinical studies focused on postoperative opioid consumption as well. One study found smokers who used more than 10 cigarettes a day had significantly higher opioid use after third molar extraction.6 Another study found smokers undergoing coronary artery bypass grafting had a 33 percent greater opioid requirement during the first 48 hours after surgery.7

In addition, the researchers examined other effects of smoking. While nicotine has been the primary culprit, any of the estimated 3,000 other constituents of cigarette smoke may also be involved in the development of pain. One study found exposure to carbon monoxide increased the level of heme oxygenase, which influences a variety of processes, including inflammation, stress and potentially neuropathic pain.8,9

Dr. Warner suggested future research go one step further: “Evidence shows smoking is a risk factor for acute and chronic pain. However, very few smokers with pain are able to quit because they feel cigarettes help them cope with their pain. We need to uncover how smoking cessation affects pain and develop practical, efficacious methods to help smokers quit.”

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The American Society of AnesthesiologistsAnesthesiologists: Physicians providing the lifeline of modern medicine. Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 45,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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1Hooten WM, Townsend CO, Bruce BK, Schmidt JE, Kerkvliet JL, Patten CA, Warner DO: Effects of smoking status on immediate treatment outcomes of multidisciplinary pain rehabilitation. Pain Med 2009; 10:347-55

2Weingarten TN, Moeschler SM, Ptaszynski AE, Hooten WM, Beebe TJ, Warner DO: An assessment of the association between smoking status, pain intensity, and functional interference in patients with chronic pain. Pain Physician 2008; 11:643-53

3Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH: Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia. Clin J Pain 2009; 25:39-43

4Weingarten TN, Iverson BC, Shi Y, Schroeder DR, Warner DO, Reid KI: Impact of tobacco use on the symptoms of painful temporomandibular joint disorders. Pain 2009; 147:67-71

5Fishbain DA, Lewis JE, Cutler R, Cole B, Steele Rosomoff R, Rosomoff HL: Does smoking status affect multidisciplinary pain facility treatment outcome? Pain Med 2008; 9:1081-90

6Berge TI: Pattern of self-administered paracetamol and codeine analgesic consumption after mandibular third-molar surgery. Acta Odontol Scand 1997; 55:270-6

7Creekmore FM, Lugo RA, Weiland KJ: Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother 2004; 38:949-53

8Slebos DJ, Ryter SW, Choi AM: Heme oxygenase-1 and carbon monoxide in pulmonary medicine. Respir Res 2003; 4:7

9Li X, Clark JD: Heme oxygenase type 2 participates in the development of chronic inflammatory and neuropathic pain. J Pain 2003; 4:101-7

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Anesthesiology (October 2010)