In some people, quit attempts might be thwarted by increases in pain reactivity. The prevalence of cigarette smoking in people with pain is higher than in the general population. Situational pain has both been found to motivate smoking behavior and been associated with relapse; furthermore, cigarette smoking is a risk factor in the onset and progression of pain, thus creating a vicious cycle. Although sustained quit attempts are associated with overall reductions in pain, early nicotine withdrawal could increase pain reactivity, potentially contributing to failure to quit. To determine whether nicotine withdrawal does increase pain, researchers randomized daily smokers to continued smoking, extended smoking abstinence (12–24 hours), or short-term smoking abstinence (2 hours). Smoking status was confirmed with measures of expired carbon monoxide. The 165 participants underwent pain induction with topical capsaicin or mechanical force. Compared with continued smoking, extended abstinence was associated with subjective ratings of greater pain intensity after capsaicin and mechanical force and with a larger area of mechanical-force–induced hyperalgesia, reflecting effects on central pain processes. Neurogenic inflammation (i.e., redness beyond the capsaicin application area) was also elevated, reflecting effects on peripheral pain processes. Short-term abstinence was associated only with a larger area of hyperalgesia. Pain-intensity ratings were correlated with severity of withdrawal symptoms. |
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Nicotine withdrawal affects both central and peripheral pain processes, although the exact mechanisms by which it increases pain are unknown. Nicotinic acetylcholine receptor availability may have a role; preliminary work elsewhere indicates that nicotine agonists like varenicline might inhibit pain via these receptors. Smokers can experience increases in pain while trying to quit. When pain is comorbid or is reported as a withdrawal-related adverse effect, clinicians can consider higher-dose nicotine replacement or teaching pain-coping strategies. Patients can be informed that increases in pain are likely temporary.