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Nursing issues
Cigarette smoking increases persistent pain intensity and interference, impairs function and sleep
  1. Felicia Cox
  1. Pain Management Service, Royal Brompton & Harefield NHS Foundation Trust, Harefield, UK
  1. Correspondence to Felicia Cox, Royal Brompton & Harefield NHS Foundation Trust, Harefield UB9 6JH, UK; F.cox{at}

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Commentary on: Khan JS, Hah JM, Mackey SC. Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain 2019;160:2374–9.

Implications for practice and research

  • Active smokers should be educated about the complex bidirectional relationship between smoking and pain.

  • Studies are required to identify targeted interventions to encourage smoking cessation and improve outcomes for smokers with persistent pain.


The association between cigarette smoking and lung cancer was described in epidemiological studies in 1950. Smoking remains a public health issue with a strong association between demographic and socioeconomic factors. Chronic pain is also related to working, socioeconomic and educational status.1 Nicotine is suspected as providing an antinociceptive (pain-relieving) effect, yet chronic smokers have an increased risk of persistent pain. Smoking cessation in people with no pain at baseline report …

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  • Twitter @FeliciaJCox

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note CONSORT = Consolidated Standards of Reporting Trials