Detox-Withdrawal and Pain in Substance Use Disorders

"Because smokers preparing for elective surgery are typically instructed to quit on hospital admission, the researchers studied individuals with a short period of cessation. The researchers demonstrated that newly abstinent smokers had significantly higher pain than nonsmokers, as well as substantially higher postoperative opioid needs for pain control. These findings confirmed earlier work from the same group showing reduced tolerance to electrical pain stimuli and greater narcotic use after surgery."

"Nicotine withdrawal leads not only to increased pain perception but also to increased emotional awareness of painful stimuli. This explains why abstinent smokers report more subjective pain and need higher postoperative analgesic doses. Surgical teams often struggle with postoperative pain management, and this new evidence explains why their analgesic needs may exceed expectations. Nicotine replacement therapy (NRT) might mitigate withdrawal-hyperalgesia, and preliminary findings do show improved pain thresholds."

Short-term abstinence from nicotine and withdrawal from opioids, cannabis, and alcohol can increase pain sensitivity and emotional responsiveness to painful stimuli. Men who recently stopped smoking before surgery experience significantly higher pain than nonsmokers and require substantially more postoperative opioids for pain control. Reduced tolerance to experimental pain stimuli accompanies higher narcotic use after surgery. Hyperalgesia from nicotine withdrawal is most pronounced during the early weeks of abstinence and gradually normalizes over about three months. Nicotine replacement therapy can reduce withdrawal-related hyperalgesia and improve pain thresholds, and surgical teams should anticipate elevated analgesic needs in recently abstinent patients.

Read at Psychology Today