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  • Doug Nelson

The Far Reaching Ramifications of Pain

I was reviewing articles in the latest issue of the journal Pain, as I always do when a new issue arrives. As I scan through the index, I look for articles that might be relevant to me as a massage therapist. My hope is to find at least a few articles in which I can apply their insights into my practice. Some of it is extremely technical and not applicable or just in areas of which I do not have experience or interest. Scanning the recent issue, I saw an article about nicotine and tobacco use, not an area of interest for me personally or for my practice. The article did, however, have pain in the title as well and that caught my attention. As it turns out, I am so glad that I read the article in it's entirety. There are wonderful and powerful insights and applications inside the article about the ramifications of pain and lifestyle. As you probably realize when out in public, the number of people who smoke has diminished markedly over the last decade or so. At present, only about 14% or so of the general population still smoke. What is fascinating is that this decrease is not at all seen in people in chronic pain. Why not? Why would they not follow the general trend? The authors cite that about 60% of smokers meet the criteria for chronic pain. Whoa! I am fascinated by bidirectionality. Here is another crazy feature of tobacco use and pain. Smoking is implicated as a risk factor in a host of pain conditions. At the same time, smoking can influence pain regulation. To quote the article-

"Pain patients who smoke also tend to report greater pain intensity/impairment than nonsmokers. Smoking may lead to dysregulated pain processing and poorer outcomes through both nicotine/tobacco-specific (eg, tissue degeneration/healing impairment) and general neurobiological effects (eg, allostatic load on overlapping pain, stress, and reward neurocircuitry." Worse yet, smokers who try to quit experience greater intensity of pain initially. That isn't exactly strong motivation to quit smoking. Yet, if they do somehow succeed, their experience of pain is substantially lessened as a non-smoker. As you might expect, stress and the experience of pain are also triggers for the desire to smoke. All of this points to the difficulty of quitting for people who also experience chronic pain. Quitting smoking is already hard, but the experience of chronic pain makes it a daunting endeavor. It's no wonder so few succeed. This is just another example of the far-reaching effects of chronic pain. Unless we have better pain management strategies, making good lifestyle choices becomes far more challenging. I also now have greater understanding and appreciation for a research study funded by the Massage Therapy Foundation. https://www.ijtmb.org/index.php/ijtmb/article/view/379/436

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