Media release

From: Society for Neuroscience

Why are abstinent smokers more sensitive to pain?

Smokers who have recently quit their nicotine use have altered brain activity linked to increased pain sensitivity and a need for more postoperative pain relief.
Abstinent smokers experience increased pain sensitivity during withdrawal, to the point that they often require more pain relief after surgery. Why? Zhijie Lu, from Fudan University Minhang Hospital, and Kai Wei, from Shanghai Eastern Hepatobiliary Surgery Hospital, led a team of researchers to explore brain activity linking nicotine withdrawal and pain sensitivity.

The researchers found that 30 abstinent smokers had altered functioning of specific brain areas, increased pain sensitivity, and a need for more postoperative pain relief—particularly with opioids—compared to 30 nonsmokers. The longer that smokers abstained from their use, the more sensitive they were to pain, which was associated with a distinct set of brain regions. Notably, this effect was constrained to a specific timeframe of abstinence, supporting previous findings that pain sensitivity may return to normal levels once abstinence exceeds 3 months. The relationship between postoperative care requirements and withdrawal symptoms from abstinence was linked to a different set of brain regions.

Says Wei, “We’d like to emphasize that our study does not discourage smokers from quitting before surgery. Our aim is to encourage researchers to delve deeper into the mechanisms underlying elevated pain sensitivity during short-term abstinence, with the goal of developing strategies to mitigate the clinical challenge of increased analgesic (especially opioid) use associated with preoperative smoking cessation.” The researchers have already begun exploring the mechanisms of a postoperative pain reliever that may be more effective than opioids in abstinent smokers as well as the mechanisms and effectiveness of preoperative nicotine replacement therapies.