Patients who are heavy tobacco users (whether chewing or smoking) do not receive long term pain relief as seen in non-tobacco users. Pain relief in tobacco smokers has been quantified by Advanced Interventional Pain Center (AIPC). For e.g. those who smoke ½ pack per day (10 cigarettes), the pain relief period following therapeutic facet injections is around 6 weeks, at which time these patients note return of pain symptoms. Those who smoke a pack per day note that pain relief is not sustained beyond 3 weeks. Heavy smokers who smoke 2-3 packs per day are not expected to get any pain relief from interventional pain procedures beyond a few days. IT IS ALSO THE OBSERVTAION OF AIPC THAT SPOUSES OF NON SMOKERS ARE AT RISK OF INHALING AT LEAST 1/2 OF A SMOKER’S TOBACCO INTAKE. This fact is further evidenced when house hold members of heavy smokers seek pain treatments at AIPC and experience poor pain relief after pain interventions characteristic of tobacco smokers. FEMALE SMOKERS ARE TWICE AS VULNERABLE AS MALE SMOKERS. For e.g. females who smoke 1/2 pack of cigarettes have poor pain relief outcomes equivalent to that of a male smoker who smokes 1 pack per day.
A similar trend is also noted in those who smoke cannabis or marijuana with lack of long term pain relief following interventional pain procedures. AIPC is however, yet to quantify the latter due to a small number of patients presented at AIPC who smoke marijuana.
The absence of long term pain relief following therapeutic injections in the aforementioned patients is due to lack of vasodilatation needed to heal the injured or inflamed anatomic pain generator following an injection. Tobacco induced vasoconstriction prevents healing and repair of the inflammatory pain focus often resulting in return of pain symptoms. Unfortunately, tobacco users with chronic pain think their pain can be cured or mitigated without tobacco cessation by undergoing highly invasive procedures under anesthesia such as open back surgery, laminectomy with or without posterior rod fixation. This line of thinking is wrong as higher the invasiveness, even worse is the outcome. A larger incision requires more blood flow to heal which a smoker is not capable of providing. Their immediate post operative pain relief is often confounded with the use of heavy narcotic and other addictive medications which have no relation to the surgical treatments they had received for pain relief. Instead of mandating tobacco cessation, often these patients are recommended spinal cord stimulators (SCS) as the next step, which also subsequently fail to provide any long term pain relief.
Along the same lines, patients with severe systemic disease such as diabetics with hearing loss, those with severe underlying cardiovascular, renal or neurological disease and those with auto immune disorders fail to improve with drug based pain interventions due to the lack of ability to improve blood flow to the treated anatomic pain generator. Unlike tobacco users however, they may respond to ablative treatments.
Unfortunately, tobacco users do not respond to any interventional or invasive pain treatment modality including ablative treatments, unless tobacco cessation has been achieved in full, at least 48 hours before procedural treatments and maintained indefinitely thereafter. AIPC has observed long term pain relief and permanent relief characteristic of non-tobacco users in patients who have discontinued tobacco use before commencement of interventional pain procedures and refrained from using tobacco thereafter. Advanced Interventional Pain Center strongly advocates for the cessation of all tobacco products as they consistently undermine the health of an individual on multiple fronts.
