Despite increasing health campaigns to create awareness of the dangers of smoking, it is still widely practised, with the World Health Organization estimating that more than eight million people will die each year from smoking-related illnesses and diseases.

Cigarette smoking leads to a wide variety of ailments and is currently the leading cause of ischaemic heart disease, chronic obstructive pulmonary disease, and lung cancer. In addition, it has a multitude of far-reaching health consequences that often go unseen.

Considering that around 80% of the world population will suffer from some form of chronic pain in their lifetime, it is crucial to be aware of just how smoking may affect chronic pain and the recovery from it.

Smoking decreases the oxygen saturation within your tissues, slowing the healing process. Because chronic pain is directly related to chronic systemic inflammation and often involves impaired healing of tissues that are acutely injured, it is more difficult to control chronic pain in smokers. In addition, smoking leads to chronic fatigue, which impairs your body’s ability to heal itself and recover from insults.

One of the major consequences of smoking is the blocking of small airways in your lungs, leading to decreased oxygen intake within the bloodstream and poor tissue delivery of oxygen-rich blood. This leads to poor uptake of nutrients and can lead to malnourishment. Malnourished individuals with micronutrient deficiencies have impaired healing and recovery from chronic pain.

Smoking also affects the quality of sleep and impairs rest, causing a chronic state of low-grade systemic inflammation and adrenaline overdrive. In the long term, this can lead to an increase in pain sensitivity and changes in the neural-pain pathways.

Because of the overlap between the neurochemical pathways of pain, anxiety and depression, a positive link has been found between smoking and depression. Depression has a direct impact on the rehabilitation and management outcomes of chronic-pain patients.

Lastly, smoking affects the function of liver enzymes, which may impair the metabolism and efficacy of pain medication used in managing pain.

Society is, however, moving in the right direction as statistics show that smoking has declined from a prevalence of nearly 21% in adults in 2005 to 13% in 2020. Ongoing awareness and educational campaigns are crucial to keep on informing the public of the often unknown and unseen dangers of smoking for managing all kinds of health issues.