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Smoking, Stress And Pain!

Updated: Feb 7, 2021

Smoking is a habit, often used as a coping mechanism due to the effect of nicotine and its perceived benefits in people who are struggling with stress. Unfortunately, its effects can be detrimental for many reasons, not to mention the negative impact of smoking on tissue and wound healing, and therefore pain. Stress in itself can impact wound healing also [3], all the more reason to implement stress management strategies as well as positive lifestyle changes such as stopping smoking, as part of a holistic programme. Improvements in diet, fluid and nutrient intake and introduction or increase in exercise / physical activity can also be hugely beneficial as well, as part of the stress and pain management toolkit.

The impact of smoking on pain can be clearly demonstrated in the literature [1,2,4,5]. Weingarten et al., (2008) found that patients with chronic pain were much more likely to experience higher pain levels and worse functioning than their non-smoking counterparts, and those with a greater nicotine dependence had more pronounced symptoms. This worsening of pain and physical functioning in smokers was also found by Khan et al. (2019), and in addition to this they also looked at the effect on factors such as sleep, emotions, anxiety and depression, which again were found to be worse in smokers with chronic pain versus non-smokers with chronic pain. For those electing to undergo hip and knee replacement surgery due to osteoarthritis (or any other surgery), this is of particular importance, not only due to the fact that they are likely to have slower wound healing, but also due to the fact that smokers, particularly heavy smokers, are likely to have more pain post-operatively and require higher levels of analgesia to manage their pain [5].

Stopping smoking almost always brings with it a sense of dread, with one of the main reasons cited by my clients as not wanting to give up being fear of putting on weight, social reasons (e.g. spouse smokes, smoking with work colleagues), or perceived inability to deal with stress/life without smoking. Obviously, the latter would be something that would already be being addressed as part of their stress management programme. It is important to work through the quitting process by using education, identifying triggers, addressing mindset and beliefs, looking at costs of smoking, reasons for quitting, cravings and potential scenarios that may push you off course, among other things.

A good stress management training programme may incorporate stress management techniques to help clients stop smoking. This can be undertaken if this is deemed as appropriate and something that you wish to work on. It is advised to undertake specific sessions to address this, and the recommendation is six separate 50-minute sessions.


[1] Khan J., Hah J., & Mackey S. (2019). Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the collaborative health outcomes information registry. Pain, 160(10): 2374-2379.

[2] Pollak K., Fish L., Sutton L., Gao X., Lyna P., Owen L., Patel M. & Somers T. (2018). A smoking cessation and pain management program for cancer survivors. Journal of cancer survivorship, 12: 821-827.

[3] Solowiej K., Mason V., & Upton D. (2009). Review of the relationship between stress and wound healing: Part 1. Journal of wound care, 18(9): 357-366.

[4] Weingarten T., Moeschler S., Ptaszynski A., Hooten M., Beebe T. & Warner D. (2008). An assessment of the association between smoking status, pain intensity and functional interference in patients with chronic pain. Pain Physician, 11: 643-653.

[5] Zanaty O. (2014). Nicotine smoking: Influences on perioperative pain management. Egyptian Journal of Anaesthesia,30(4): 373-376.

Please note: This article is intended to be for educational purposes only, and does not constitute medical advice or replace professional assessment or personalised advice.

I do not hold responsibility for the information on any links to external websites within this article and information within these links/websites may change at any time or no longer be accessible. Any website pages/links added are also for education purposes only.


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