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Smoking and chronic pain – a bad combination

Issue 37 Synovium (Autumn 2012)

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In a rather complex study presented at the International Association for the Study of Pain (IASP) 14th World Congress on Pain,1 the association between smoking and pain was explored along with the prevalence of depression and anxiety. 971 patients with chronic pain were assessed using the American College of Rheumatology (ACR) criteria for fibromyalgia. 347 patients satisfied the criteria and were described as having ‘centralised’ or FM+ pain. In patients with FM+ pain smoking prevalence was 40% as compared with 26% in FM− patients with chronic pain and 20% in the general population. FM+ smokers had more severe pain, more pain interference, more neuropathic pain, more depression and more anxiety (patients were assessed using the Brief Pain Inventory, the PainDETECT questionnaire and the Hospital Anxiety and Depression Scale) compared with non-smokers. Cause or association? Or a coping strategy? Difficult to say. However, ex-smokers had similar pain, depression and anxiety scores to ‘never smokers’. So in addition to all the usual reasons for stopping smoking it sounds sensible to advise patients with chronic pain that smoking is associated with increased pain, more depression and more anxiety. 

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