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Does smoking hurt as well as harm? (or, as if you needed another reason)



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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I have a couple of mates who are veritable smoke-stacks. They love smoking but sort of hate being a smoker. I must confess that, at least within my community, smoking is now officially uncool and my mates are sick of people telling them good reasons to give up.  Well, as if they needed another reason, here is evidence that smoking hurts.  This is a huge study and we are thrilled that the lead author Charlotta Pisinger agreed to write a blurb for us.

Tobacco smoke and frequent pain

Whereas the causal link between smoking and e.g. cardiac pain is now established and well understood, the influence of smoking on back pain and other musculoskeletal pain has been a topic of controversial discussion.

Our study took place in Copenhagen, Denmark. The study included almost 7000 persons (30 to 60 years) randomly selected from a general population. Our aim was to investigate the relationship between frequent pain (daily or often) and both active and passive smoking. Pain was self-reported and included six different kinds of pain: headache, pain in lower back in lifting, pain in lower back radiating to legs, pain in neck and upper back, pain in joints and pain in abdomen.

Daily smokers reported to suffer from frequent pain in every of the six locations twice as often as never smokers. Occasional smokers reported a little less pain than daily smokers, ex-smokers even less pain and never smokers the least. The more cigarettes smoked, the more frequently pain was reported. Also, an early smoking debut and smoking for many years increased the probability of frequent pain.

One could argue that smokers are different from non-smokers and have pain due to quite other reasons than smoking. Therefore, we decided to look at non-smokers exposed to environmental tobacco smoke (ETS). We found that the more non-smokers were exposed to tobacco smoke the more pain they experienced. Non-smokers exposed to tobacco smoke at least 5 hours daily had significantly, about 50%, more frequent pain than those almost never exposed.

Two other studies have found and association between ETS and pain in the back and headache. Together with results from our study this confirms a casual link between tobacco smoke and pain.

So, why do smokers have more pain? We know that tobacco smoke contains carbon monoxide and other toxic gases, and previous research had shown that smoking leads to reduced perfusion and malnutrition of tissues, inhibits cell proliferation and increases inflammation, speeds up the degenerative process in the disc and weakens the spinal ligaments.  Furthermore, tobacco smoke influences the central system. Deprivation of cigarettes appears to diminish smokers’ sensitivity to pain significantly below that of non-smokers, and diminished pain tolerance in smokers has been shown to result in requiring higher dosages of pain-killers. As smokers exhibit short-term pain reduction after smoking, they will light a cigarette when they experience pain. Unfortunately every cigarette worsens their pain, and a vicious circle arises.

About Charlotta

Charlotta Pisinger is Senior Research Fellow, MD Consultant, PhD, MPH at the Research Center for Prevention and Health, Department of Development and Health, Capital Region of Denmark, Denmark.


ResearchBlogging.org Pisinger C, Aadahl M, Toft U, Birke H, Zytphen-Adeler J, & Jørgensen T (2011). The association between active and passive smoking and frequent pain in a general population. European journal of pain (London, England), 15 (1), 77-83 PMID: 20627783

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