Abstinent smokers become more sensitive to pain during withdrawal and often need more pain relief after surgery. Why?

A new study in JNeurosci led by Zhijie Lu (Fudan University Minhang Hospital) and Kai Wei (Shanghai Eastern Hepatobiliary Surgery Hospital) mapped brain activity to investigate the link between nicotine withdrawal and pain sensitivity.

Comparing 30 smokers who had quit briefly with 30 nonsmokers, the team found altered activity in specific brain regions, greater pain sensitivity, and higher postoperative analgesic use—especially opioids—among the abstinent smokers. Within that abstinence period, longer time off cigarettes was associated with greater pain sensitivity and with changes in a distinct set of brain areas. Importantly, this effect appeared limited to a particular window of abstinence: it aligns with earlier evidence that pain sensitivity may return to baseline once abstinence exceeds three months. The connection between increased postoperative care needs and withdrawal symptoms involved yet another set of brain regions.

“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.” — Kai Wei, Shanghai Eastern Hepatobiliary Surgery Hospital

The researchers are already exploring a postoperative pain reliever that might work better than opioids in abstinent smokers, and they are studying the mechanisms and effectiveness of preoperative nicotine replacement therapies.

This article was adapted from an original report published on news-medical.net. All rights belong to the original publisher.