Are Neuropathy Patients Likely To Be Heavy Smokers, Or Vice Versa?

Today's post from medscape.com (see link below) seems not to be sure on which side of the fence it sits. The statistics show that far more people with nerve pain smoke heavily than those with nociceptive pain (pain caused by injury and external factors). The article seems to suggest a link between the light analgesic qualities of tobacco/nicotine and that pattern - as if to say that nerve pain patients use cigarettes as a mild pain killer. Yet it is patently clear that the harmful effects of nicotine far outweigh the benefits so it is doubtful that patients consciously make the choice to smoke to chemically ease their pain. Is it not more likely that people with nerve pain are so stressed out by the nature of their symptoms that cigarettes perform their traditional role of 'comforter' in much the same way that over-eating and over-drinking do? The vast majority of neuropathy articles also point to smoking as a cause of neuropathy, so where does that leave us? Whatever the truth, the fact remains that there are more heavy smokers among neuropathy sufferers than those with other forms of pain - the question remains as to why!

People With Neuropathic Pain Twice as Likely to Smoke Cigarettes
Stephanie Doyle February 18, 2008

February 18, 2008 (Kissimmee, Florida) — Results of a new study suggest that people with chronic neuropathic pain are twice as likely to smoke cigarettes as those who have chronic nociceptive pain.

The study, led by Toby N. Weingarten, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, showed that of the 205 smokers who participated in the study, 62% had been diagnosed with neuropathic pain, whereas only 33% had been diagnosed with nociceptive pain.

"To us that is surprising — we were surprised that smoking would influence what type of pain smokers had," Dr. Weingarten told Medscape Neurology and Neurosurgery.

The results were presented here at the American Academy of Pain Medicine 24th Annual Meeting.

Poor Response to Medications

Nociceptive pain is the common discomfort experienced as a result of injury, such as a broken bone or appendicitis. Neuropathic pain is associated with injury to a nerve or the central nervous system. Such injuries can give rise to paresthesias, such as numbness, tingling, or electrical sensations.

Nociceptive pain typically responds to anti-inflammatory agents and opiates, whereas neuropathic pain often responds poorly to such medications.

In the current study, the authors aimed to determine the percentage of community subjects with chronic neuropathic pain who smoke. Subjects were recruited from a large population-based study to assess the prevalence of chronic pain.

These adults had self-reported neuropathic pain, were identified from patient charts as having neuropathic pain, or had a positive score on the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), a tool designed to identify patients with neuropathic pain. They also self-reported current smoking status.

The percentage of participants confirmed as having neuropathic pain by clinical assessment who also smoked was 21%, compared with 13% in the overall sample (P = .009). Smoking was twice as common (62% vs 33%) in subjects who were diagnosed by clinical assessment as having neuropathic pain as nociceptive pain.

The percentages of those who smoked varied by positivity on screening tests for neuropathic pain: 18% for a positive S-LANSS score, 12% with self-reported neuropathic pain, and 8% of those with select ICD-9-CM codes from patient charts.

"The possible physiologic relation between smoking and development of chronic neuropathic pain deserves further evaluation," the authors conclude.

Not Advocating Smoking

"This study is intriguing," said Todd Sitzman, MD, MPH, president of the American Academy of Pain Medicine. "Clinical studies have shown a modest analgesic effect from nicotine. Although there is an association between nicotine and neuropathic pain, there is no direct causative effect."

However, Dr. Sitzman, who was not involved with the study, told Medscape Neurology and Neurosurgery: "I caution advocating smoking as a perceived treatment for neuropathic pain, since it is clear that the adverse risks of smoking outweigh any potential benefit."

Funding was provided by AstraZeneca and the National Institutes of Health. Dr. Weingarten has disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 24th Annual Meeting: Abstract 100.

Medscape Medical News © 2008

http://www.medscape.com/viewarticle/570347