In the pain clinic where I work, 21% of the patients with chronic pain smoke
cigarettes, this is one in five people with chronic
pain. Why do they smoke if smoking makes pain
worse, and has so many bad health consequences?
In this video, we will explore some reasons why people smoke,
and I will suggest some strategies for people to quit smoking.
So stay tuned,. Let's talk about smoking and pain.
Most people don't know that smoking cigarettes predisposes a person to have
more chronic pain, like low back pain, rheumatoid arthritis, headaches, and
neuropathic pain. People with chronic pain who smoke have
higher pain intensity, further disability, and increased
depression than people with chronic pain who do not smoke.
However, most people also don't know that nicotine
has analgesic properties, which means it's a painkiller.
What? Did I hear it right? Yes. It's an interesting paradox here.
Nicotine decreases pain and nicotine increases pain.
Scientists showed that in people who do not have chronic pain
and volunteer to an experiment to provoke pain,
they will report less intense pain if giving them nicotine before the
experiment. This is more obvious in men than women.
This experiment shows that nicotine is an analgesic. It occurs mainly at the
brain level, when the nicotine activates the
nicotinic acetylcholine receptors, or nAChR which results in the release of
opioids and norepinephrine in the brain. This
will also block the pain activating pathways,
and will activate the pain inhibitory pathways in the pain system.
But then, why do people who smoke cigarettes
have more chronic pain? Well, there are many different mechanisms for this to
occur. First there are 4 000 substances in a
cigarette and when people smoke every day, the
substances will damage many body tissues and organs,
like impaired bone healing, wound healing, causing osteoporosis, disc disease,
the carbon monoxide will lead to poor oxygenation to organs.
Second, is the deregulation of the pain system.
Neuroplastic changes leading to nociplastic pain,
See another video that I made where I explain nociplastic pain.
Third, they also interact with opioids causing cross tolerance, and altered
breakdown of the opioids. Fourth, nicotine causes altered mood.
People who smoke are more depressed. Nicotine increases the hormone
epinephrine that increases blood pressure.
But also affects mood and anxiety. And fifth, the nicotine in tobacco lead
to nicotine dependence. Nicotine will reach the brain within a
few seconds after the first inhalation. It will
release dopamine which is the neurotransmitter of
pleasure and reward. Also nicotine withdrawal symptoms are
very severe. Now we know that smoking leads to more
pain, depression, irritability and is very addictive. But
these are not the only bad effects of smoking cigarettes.
They also cause high blood pressure, stroke,
heart attack, stomach ulcers, poor appetite,
impotence, infertility, asthma, emphysema, bronchitis, bad breath, altered taste,
stained teeth, gray skin, wrinkles, weakened bones,
arteries clogged that can lead to amputations,
and various types of cancer. I know many orthopedic surgeons who
would not operate on someone who smokes cigarettes, that's because smoking
impairs oxygenation delivery to the tissues,
including the bones, impairing the bone healing, wound healing,
and could contribute to complications after surgery, such as infections,
poor healing, and pain.
It's unbelievable, but there are 18 billion
cigarettes that are smoked every day in the world.
So why do people with chronic pain smoke? People
smoke for a variety of reasons, and that's why it's so hard for them to quit.
It just takes a few days to develop a tobacco addiction.
So the best option is not to start. Once a person starts smoking their body
will start opening up those nicotinic acetylcholine receptors,
and they will crave their nicotine. Absence of nicotine causes irritability,
anxiety due to the dependence, and these cravings
will be all they can focus on, until they calm down those receptors.
Think of addiction like the young birds in the nest,
screaming to get food from the mother bird.
The nicotine receptors are screaming to get that nicotine.
And they will only stop when they receive what they want.
There is a questionnaire that people can answer to know how bad
their nicotine dependence is. the Fagestron
test for nicotine dependence has a number of questions,
that depending on how you respond, it will show if a person has
more severe, or less severe nicotine dependence.
Some of these questions are like: How soon after you wake up do you smoke your
first cigarette? Do you find it difficult to refrain from
smoking in places where it's forbidden? Like churches, or library, or cinemas?
Which cigarette would you hate most to give up?
How many cigarettes per day do you smoke? Do you smoke during the first
hours after waking up? During the rest of the day?
Than during the rest of the day? And do you smoke even when you are ill enough
to be in bed most of the day? A person that scores
five or more indicates a severe significant
dependence on nicotine. But nicotine dependence is not the only reason why
people smoke. Sometimes it's just a habit of holding a
cigarette, to keep something in the hands, or simply
pleasure to watch the smoke, to socialize with
friends, to give a lift, or to take the mind off
the worries of life. Some people keep smoking because they
don't want to gain weight. Well, if they quit, it's interesting that
the weight gain is between two and five pounds, but the health
benefits of quitting are so much higher than the risk of gaining
just 5 pounds. Lastly, for people with chronic pain, one
of the reasons they keep smoking is because
pain is their motivator. Some people who endorse
pain induced desire to smoke. They will say:
My smoking is extremely related to my pain. "Istead of rubbing my knee
i'll go smoke a cigarette" "if I have a flare up,
i'll go for a cigarette". Some people will endorse
smoking for pain coping, for example like a distraction,
"I'm thinking of a cigarette, puffing it, and lighting it,
and holding, it so it diverts me away from the pain"
Some people will say: "Smoking is a great distraction tool"
Some people report that opioid increase the urge to smoke.
I have seen people saying "When i was in opioids
it was making me like a chain smoker" Because of the interactions that we have
in the brain, that opioids and nicotine increase the
codependency, so those are the reasons why some people
with chronic pain will be smoking. So now,
let's talk about quitting smoking. There are many options for people who want to
quit smoking. You should talk to your doctor if you
are interested in quitting. Remember that you may fail many times,
but if you keep trying, one day you will certainly be able to
quit forever, don't give up! There are many resources and options to
help people who want to quit. Nicotine replacement therapy to reduce
the cravings. They come in various forms like gums,
lozenges, patches, inhalers, and mouth sprays.
The patch is more long-acting NRT while the others are more like
short-acting, and help reduce the breakthrough cravings.
E-cigarettes and vaping are currently being investigated by Health Canada
as alternative methods for quit smoking. Medications to block the effects of
nicotine such as varenicline, or to make the smoking less pleasurable
like bupropion. Also, it's important to know your
triggers and avoid them, like alcohol, coffee, meals, stress,
being around smokers, parties, breaks, watching tv,
driving, and so on. What if you have cravings?
Remember the four D's. The first d is delay. Delay the craving.
The craving rarely lasts more than a few minutes,
and do some activities to pass the time. The second one
is to distract your mind when craving hits.
Stop what you are doing do something else. The third one
is deep breathing, inhale through your nose,
hold it for five seconds, slowly breathe out
through your mouth, count to seven, and repeat this
a few times. And the fourth D is drinking water. Actually it helps.
It helps to reduce the hand to mouth behavior,
it helps change the taste in your mouth, and will actually reduce the craving,
try sipping slowly, holding the sip in your mouth for a few seconds.
And what to do if you're having withdrawal symptoms from the nicotine?
Well anxiety. Anxiety is very common. Go for a walk, do deep breathing,
do some exercise, and try to drink less coffee.
Another symptom of withdrawal from nicotine is fatigue.
So, it can take up to four weeks for your energy level to return to
normal, and try getting more rest, exercising more, drinking lots of water.
Another one is difficulty concentrating. So try to eat small amount of food every
few hours instead of three big meals. Another one is feeling sad, feeling
depressed. Try to get support from friends, family,
or support groups, and talk to your doctor. Other people may
feel anger, so talk to people close to you,
accept your emotions, vent your feelings in a safe environment.
Other people may have increased appetite. Try to eat
smaller amounts more often, choose healthy snacks, such as carrot sticks.
Other people may have constipation, try to increase the amount of fiber in your
diet, drink more water and reduce the caffeine.
And some people will have insomnia. Try relaxation exercise before bedtime,
reduce the caffeine during the day. And don't forget, there are many
resources for people who want to quit smoking.
Many support groups in Canada. Many websites, online.
I will describe many of those resources in the description of this video below.
Now please remember that this video is not intended to provide medical advice.
It's just for educational purposes, if you think you have nicotine addiction or
chronic pain that is associated with smoking,
please consult your doctor to get medical advice in a treatment plan for
you. If you like this video don't forget to
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watching. Bye.