Smoking and postoperative pain
This study aimed to examine the effects of long-term smoking and nicotine dependence on pain following surgery.
107 male participants who were undergoing elective thoracoscopic lung cancer surgery were divided into 3 groups:
- those who had a high nicotine dependency and discontinued smoking less than 3 weeks before surgery;
- those who had a high nicotine dependency but quit smoking more than 3 weeks post surgery; and
- non-smokers.
After participants were allocated to one of the groups, the researchers educated them about the visual analogue scale (VAS) for pain. The participants all underwent the same surgery type, with the same amount of ventilation with 40% oxygen.
Post-operatively, the PCA (patient-controlled analgesia) was administered, with a maximum of opiod dose of 40mL in 4 hours. If the patient reported pain greater than a 6/10 on the VAS scale, a bolus of tramadol for 100 mg could be administered, but no other pain relief was given.
Of the groups, the group that had no nicotine dependency had lower pain scores up to 48 hours post-operatively, and the group with nicotine dependency that had quit smoking less than 3 weeks before surgery scored the highest with VAS and PCA use.
This article is one of the first to examine the neurological correlation between nicotine dependency and the neurological pathways of the brain and reporting of pain.
It also highlights the importance of considering the full history of a patient – and not just the classification of a smoker or a non-smoker. The level of nicotine dependency is an important consideration, and from a rehabilitation viewpoint this is worth noting in advance, as this could impact the therapist’s approach.
Expert opinion by Jessica Povall
This article highlights smoking and nicotine dependency as a factor influencing pain following surgery.
While nicotine is known to impact healing and recovery, it is important to highlight the strong neurological impact smoking can have. It would be interesting to highlight smoking and nicotine dependency in other persistent-pain conditions.
> From: Zhao et al., Medicine (Baltimore) 98 (2019) e14209. All rights reserved to The Author(s). Click here for the online summary.
