Smoking increases chronic postsurgical pain in patients undergoing open abdominal hysterectomy

Abstract

Objectives: Smoking cause severe postoperative complications. Cotinine is the end product of nicotine in the urine. Our primary hypothesis was that women with high preoperative urinary cotinine levels have more postsurgical chronic/acute pain is tested, and secondarily, that high cotinine levels are associated with more opioid consumption. Method: 158 patients undergoing open abdominal hysterectomy were divided into three groups according to the cotinine level. 1)Low Cotinine group ˂10ng/dl (no exposure), 2) Intermediate Cotinine group =10-500ng/dl (exposure), 3) High Cotinine group ˃500ng/dl (smoker). In postoperative 3 months, postsurgical chronic pain, allodynia score, pain limiting daily activity, Brief Pain Inventory, SF 12 form, Douleur Neuropathique en 4 (DN4) questions test, and Sleep interference test were assessed. Visual Analogue Scale (VAS), morphine consumption, rescue analgesic consumption, and complications were recorded during postoperative 48 hours. Results: The postsurgical chronic pain scores at the three months(p˂0,007), the postoperative pain scores and opioid consumption were significantly higher in the high cotinine group. High cotinine group had significantly worst HADS, SF 12 PCS, allodynia, and sleep interference test scores. Conclusion: Smoking and tobacco smoke exposure are associated with high postsurgical chronic pain, and also postoperative acute pain with more opioid consumption.

Keywords

• Cotinine
• Pain
• Smoke

References

1. Prütz F, Knopf H, von der Lippe E, Scheidt-Nave C, Starker A, Fuchs J. Prävalenz von Hysterektomien bei Frauen im Alter von 18 bis 79 Jahren. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2013;56(5):716-22. https://doi.org/10.1007/s00103-012-1660-7
2. Correll D. Chronic postoperative pain: recent findings in understanding and management. F1000Research. 2017;6. https://doi.org/10.12688/f1000research.11101.1
3. Málek J, Ševčík P. Postoperative Pain Management. Praha: Mladá fronta DNES, 3rd updated revision. [online][2019-12-19]. 2017. https://doi.org/10.32725/kont.2020.018
4. Pokkinen SM, Nieminen K, Yli-Hankala A, Kalliomäki M-L. Persistent posthysterectomy pain: a prospective, observational study. European Journal of Anaesthesiology| EJA. 2015;32(10):718-724. https://doi.org/10.1097/EJA.0000000000000318
5. Harker J, Reid KJ, Bekkering GE, et al. Epidemiology of chronic pain in Denmark and Sweden. Pain research and treatment. 2012;2012 https://doi.org/10.1155/2012/371248
6. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults—United States, 2005–2015. Morbidity and Mortality Weekly Report. 2016;65(44):1205-1211. https://doi.org/10.15585/mmwr.mm6544a2
7. Control CfD, Prevention. Mortality trends for selected smoking-related cancers and breast cancer--United States, 1950-1990. MMWR Morbidity and mortality weekly report. 1993;42(44):857-866. PMID: 8232168
8. Hong D, Conell-Price J, Cheng S, Flood P. Transdermal nicotine patch for postoperative pain management: a pilot dose-ranging study. Anesthesia & Analgesia. 2008;107(3):1005-1010. https://doi.org/10.1213/ane.0b013e318163204f

9. Ditre JW, Heckman BW, Zale EL, Kosiba JD, Maisto SA. Acute analgesic effects of nicotine and tobacco in humans: a meta-analysis. Pain. 2016;157(7):1373. https://doi.org/10.1097/j.pain.0000000000000572
10. Montbriand JJ, Weinrib AZ, Azam MA, et al. Smoking, pain intensity, and opioid consumption 1–3 months after major surgery: a retrospective study in a hospital-based transitional pain service. Nicotine and Tobacco Research. 2018;20(9):1144-1151. https://doi.org/10.1093/ntr/ntx094
11. Madsbu MA, Salvesen Ø, Werner DA, et al. Surgery for herniated lumbar disc in daily tobacco smokers: a multicenter observational study. World neurosurgery. 2018;109:e581-e587. https://doi.org/10.1016/j.wneu.2017.10.024
12. Weingarten TN, Podduturu VR, Hooten WM, Thompson JM, Luedtke CA, Oh TH. Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia. The Clinical journal of pain. 2009;25(1):39-43. https://doi.org/10.1097/AJP.0b013e31817d105e
13. Benowitz NL, Hukkanen J, Jacob P. Nicotine chemistry, metabolism, kinetics and biomarkers. Nicotine psychopharmacology. 2009:29-60. https://doi.org/10.1007/978-3-540-69248-5_2
14. Wiener RC. Serum Cotinine and Chronic Pain: NHANES 2003–2004. Journal of drug abuse. 2015;1(1) https://doi.org/10.21767/2471-853X.10003
15. Weingarten TN, Shi Y, Mantilla CB, Hooten WM, Warner DO. Smoking and chronic pain: a real-but-puzzling relationship. Minnesota medicine. 2011;94(3):35-37. PMID: 21485923
16. Elmacıoğlu MA. Kronik Ağrı Mekanizmaları, Nöral Terapi ve Ortomoleküler Destek Tedavileri. Bilimsel Tamamlayıcı Tıp Regülasyon ve Nöral Terapi Dergisi. 11(1):6-11.
17. Ceyhan D, MS G. Postoperatif ağrı sadece nosiseptif ağrı mıdır. Ağrı. 2010;22(2):47-52.
18. Zanaty OM. Nicotine smoking: Influences on perioperative pain management. Egyptian Journal of Anaesthesia. 2014;30(4):373-376. https://doi.org/10.1016/j.egja.2014.05.007
19. Shen L, Wei K, Chen Q, et al. Decreased pain tolerance before surgery and increased postoperative narcotic requirements in abstinent tobacco smokers. Addictive behaviors. 2018;78:9-14. https://doi.org/10.1016/j.addbeh.2017.10.024
20. Goodwin RD, Wall MM, Choo T, et al. Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990–2001. Annals of Epidemiology. 2014;24(7):493-497. https://doi.org/10.1016/j.annepidem.2014.01.014
21. Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107(1-2):54-60. https://doi.org/10.1016/j.pain.2003.09.015
22. Zale EL, Ditre JW. Pain-related fear, disability, and the fear-avoidance model of chronic pain. Current opinion in psychology. 2015;5:24-30. https://doi.org/10.1016/j.copsyc.2015.03.014
23. Weingarten TN, Moeschler SM, Ptaszynski AE, Hooten WM, Beebe TJ, Warner DO. An assessment of the association between smoking status, pain intensity, and functional interference in patients with chronic pain. Pain physician. 2008;11(5):643-653. https://doi.org/10.36076/ppj.2008/11/643
24. Liao Y, Xie L, Chen X, et al. Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China. BMC public health. 2019;19(1):1-9. https://doi.org/10.1186/s12889-019-6929-4
25. Phillips BA, Danner FJ. Cigarette smoking and sleep disturbance. Archives of internal medicine. 1995;155(7):734-737. https://doi.org/10.1001/archinte.1995.00430070088011
26. Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC public health. 2012;12(1):1-10. https://doi.org/10.1186/1471-2458-12-203
27. Tillmann M, Silcock J. A comparison of smokers' and ex-smokers' health-related quality of life. Journal of Public Health. 1997;19(3):268-273. https://doi.org/10.1093/oxfordjournals.pubmed.a024629
28. Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. Bmj. 1998;316(7133):736-741. https://doi.org/10.1136/bmj.316.7133.736
29. Guitérrez-Bedmar M, Seguí-Gómez M, Gómez-Gracia E, Bes-Rastrollo M, Martínez-González MA. Smoking status, changes in smoking status and health-related quality of life: findings from the SUN (“Seguimiento Universidad de Navarra”) cohort. International Journal of Environmental Research and Public Health. 2009;6(1):310-320. https://doi.org/10.3390/ijerph6010310
30. Lee PN. Uses and abuses of cotinine as a marker of tobacco smoke exposure. Analytical determination of nicotine and related compounds and their metabolites. Elsevier; 1999:669-719. https://doi.org/10.1016/B978-044450095-3/50017-6
31. Gorrod JW, Schepers G. Biotransformation of nicotine in mammalian systems. Analytical determination of nicotine and related compounds and their metabolites. 1999:45-67. https://doi.org/10.1016/B978-044450095-3/50004-8
32. Control CfD, Prevention. National Health and Nutrition Examination Survey 2003–2004. Documentation, codebook and frequencies Available online: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/dr1iff_c pdf (accessed on 3 March 2013).
33. Jarvis MJ, Russell M, Benowitz NL, Feyerabend C. Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure. American journal of public health. 1988;78(6):696-698. https://doi.org/10.2105/AJPH.78.6.696
34. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley III JL. Sex, gender, and pain: a review of recent clinical and experimental findings. The journal of pain. 2009;10(5):447-485. https://doi.org/10.1016/j.jpain.2008.12.001
35. Erskine R. Do I advise my patient to stop smoking pre-operatively? Curr Anaesth Crit Care. 1992;3:175-180. https://doi.org/10.1016/S0953-7112(05)80142-5
36. Hukkanen J, Jacob P, Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacological reviews. 2005;57(1):79-115. https://doi.org/10.1124/pr.57.1.3
37. Pirkle JL, Bernert JT, Caudill SP, Sosnoff CS, Pechacek TF. Trends in the exposure of nonsmokers in the US population to secondhand smoke: 1988–2002. Environmental health perspectives. 2006;114(6):853-858. https://doi.org/10.1289/ehp.8850
38. Caraballo RS, Giovino GA, Pechacek TF, et al. Racial and ethnic differences in serum cotinine levels of cigarette smokers: Third National Health and Nutrition Examination Survey, 1988-1991. Jama. 1998;280(2):135-139. https://doi.org/10.1001/jama.280.2.135