Cancer patients who smoke report worse pain

Patients with cancer that continued to smoke despite their diagnosis reported experiencing greater pain than nonsmokers, according to new study findings.

Joseph W. Ditre, PhD, of the Texas A&M University in College Station, and colleagues from several other U.S. sites analyzed self-reported pain severity, pain-related distress and pain-related interference among 224 patients with a variety of cancer diagnosis. These included breast (35%), lung (33%), bladder (6%), ovarian (6%), colon (4%) and other less common types of cancer. All patients were about to initiate outpatient chemotherapy.

Participants rated their perceived sense of bodily pain and the degree to which this pain interfered with daily activities on scales of 1-to-6.

The researchers determined that current smokers reported more sever pain than never smokers, and more interference from this pain than both never smokers and former smokers, regardless of cancer type. Data also revealed an inverse relationship between pain and the number of years since quitting among former smokers, with pain severity decreasing as the number of years since quitting increases.

Ditre and colleague Thomas H. Brandon, PhD, of the University of South Florida and the Moffitt Cancer Center, both in Tampa, hypothesized that “smoking may serve as a marker and/or risk factor for the incidence and severity of chronic nonmalignant pain,” in an earlier study (J Abn Psychol 2008;117:467-72).

They suggested that tobacco smoke reduces blood and oxygen flow to peripheral tissues, influencing how the brain processes sensory information and potentially increasing the severity of perceived pain.

Another possible mechanism is that pain may motivate individuals to use smoking as a coping mechanism, conversely leading to more tobacco use, worse nicotine dependence and greater pain, according to Ditre and Brandon. “An important clinical implication of this consideration is that cancer patients who become increasingly reliant on tobacco for stress-coping and self medication may become less motivated to quit smoking,” they wrote.

Lori Bastian, MD, MPH, interim division chief of general internal medicine at Duke University School of Medicine in Durham, N.C., noted that the relationships between pain, cancer and nicotine addiction are complex, in an accompanying editorial.

“Although more research is needed to understand the mechanisms that relate nicotine to pain, physicians should aggressively promote smoking cessation among cancer patients,” Bastian wrote.

The full study and Bastian's editorial will be published in the Jan. 2011 issue of Pain.

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