Smoking and musculoskeletal pain

Help your patients quit smoking today

Smoking has negative effects on musculoskeletal function, injury, & surgical outcomes

Although the effects of nicotine on musculoskeletal function and injury are not fully understood, cigarette smoking is associated with:

• Lower bone mineral density(BMD), increased fracture risk, periodontitis and alveolar bone loss³

• Increased joint disease activity and poor functional outcomes³

• Immune suppression, reduced cellular oxygenation, and delayed nutrient progression to injury sites, which can increase injury risk and delay healing*⁴

_{* study was conducted on meniscal injury}

The relevance of cigarette smoking on musculoskeletal problems is still underestimated⁵.

• Cigarette smoking worsens the prognosis of several orthopaedic disorders and surgical procedures^5,6

• Most common complications from orthopaedic surgery caused by smoking include: poor wound healing, infection and poor final outcomes of surgery^5,6

Daily tobacco smokers often experience greater pain following periods of smoking abstinence⁷

• Smoking is considered one of the factors that complicate pain management²

• Since pain intensity ratings were positively correlated with the severity of nicotine withdrawal symptoms, controlling these symptoms is important not only in smoking cessation interventions but also in pain relief care²

• Smokers require greater opioid doses for pain relief than non-smokers, but despite their higher doses, they show greater pain intensity scores²

Smokers will benefit from smoking cessation interventions that are tailored to account for pain amplification during early stages of quitting⁷

Smoking cessation as a consideration to help reduce chronic pain

A 2022 consensus statement from Japan strongly recommended smoking cessation to help improve chronic pain, based on the result of a systematic review and meta-analysis:²

• Smoking cessation helps alleviate pain by preventing the aggravation of tobacco-related diseases and other pain- causing pathologies²

• In smokers with chronic pain, nicotine withdrawal increases pain intensity. Therefore, to increase the likelihood of abstinence, the use of smoking cessation aids is advised vs willpower alone²

Encouraging your patients to avoid or quit smoking can reduce their risk of incurring many musculoskeletal problems⁹

Sufficient smoking abstinence can reduce post - operative pain

• Smokers show higher acute pain intensity scores postoperatively than non smokers, and require greater opioid analgesic doses. These trends are more pronounced with higher levels of nicotine dependence²

• Patients show lower post-operative acute pain scores, when starting smoking abstinence >3 weeks before surgery than when starting it immediately before surgery²

These findings underscore the need for a sufficient duration of smoking abstinence before surgery to minimise the adverse effects of smoking²

The essential role of HCPs in getting patients to stop smoking

• You have the chance to help improve your patient's pain-causing conditions, their health and overall life expectancy²

• Even less than 3 minutes of discussion can increase smoking cessation and abstinence rates by 40%¹⁰

• 85% of patients would appreciate their physician bringing up the topic of smoking cessation¹¹

• Two-thirds of smokers say they want to quit, but most try to do so unaided, which is the least effective method¹²

• 96% of smokers will fail to quit smoking with willpower alone¹³

How HCPs can help patients with musculoskeletal pain to stop smoking

Patients have a 3-5x increased chance of quitting with stop-smoking aids and behavioural support^14,15

Pain practitioners and smoking cessation therapists could:

• Develop patient awareness and education with support on smoking cessation¹²

• Use relevant treatment protocols and counselling to help patients achieve pain alleviation and smoking cessation²

• Recommend stop smoking aids like NRT or prescription medicines and provide ongoing support¹⁶