Rx from the P.A.’s: On Smoking Cessation
Our last article focused on the special risk long-term smoking poses to people with chronic pain. This week, we are continuing the conversation. BRPM’s own Laura Davis, P.A., is especially knowledgeable and understanding when it comes to the difficulties of smoking cessation. We asked Laura about her personal experience with smoking and what she did to quit:
Smoking is something that I never thought I would start. My parents smoked my whole life and I despised it. I tried it when I got older and was addicted immediately. I understand the addiction and understand how hard it is quit, not only for myself but with my family and friends.
In short, it’s the nicotine. The nicotine found in cigarettes is very addictive. It becomes more difficult to quit as the craving for nicotine continues. One quote I have read is “One of the main reasons people still smoke today is that they started smoking in the first place,” which was definitely true for me. I continued to smoke because I enjoyed talking on the phone and smoking a cigarette. I enjoyed sitting out back with friends and smoking.
Numerous studies have shown how smoking and nicotine affects chronic pain, including low back pain, sciatica, fibromyalgia, knee pain, etc. Smoking decreases the amount of oxygen your blood delivers to body tissues. That’s why smoking can cause the thinning of bones called osteoporosis and makes it harder for your body to heal and repair damage after an injury. We do know that nicotine decreases sensitivity to pain in its early state (acute), but that decreased sensitivity wears off. Once the pain-decreasing effect of nicotine wears off, pain may actually be worse. Current theory suggests that people start smoking to help with their new (acute) pain, but need to continue smoking to relieve chronic pain.
I quit cold turkey. I never really tried any other techniques. At the beginning, I only smoked socially. After a year or so, that increased. I never really thought about quitting because I liked it. It made me feel happy and suppressed my appetite. As I got into my late 20’s, I was finding that I was becoming more disgusted when I smoked. I always told my husband, when I get pregnant I will quit. I was standing on my back porch smoking one day and the neighbor came out to tell me his wife was pregnant. He asked me when Josh and I were going to try. I responded that we are already. Being the nice guy he is, he said good luck and I said congratulations and he went inside. I stood there for a minute and looked down on my cigarette and thought, “How selfish am I? I am standing outside, smoking, and talking about trying to have a baby and I’m going to quit when I get pregnant?” I put my cigarette out, walked inside, threw my cigarettes away and told my husband I wasn’t smoking anymore. He quit two days later. Neither of us have smoked since.
I don’t think there is one technique that is better than the other. I think it differs from person to person. I think the biggest and most common factor with smoking cessation is motivation. If the person isn’t motivated, they won’t quit. They might quit short term but will pick it back up again. There are many nicotine products that are available, like the patch, gum, etc. These all more or less try to wean the patient off Nicotine over time. There are prescription medications to help satisfy cravings without the nicotine, but they are expensive and have side effects. If the patient is ready and highly motivated, I encourage them to just throw it out and push through. Another technique I tell patients is to eliminate 1 cigarette a week. A lot of folks like that because they feel like they have some control over it. My parents were hypnotized. My mom quit for 6 months but started back. My dad has quit indefinitely. I think the best thing you can do is find something that will motivate you. For me, it was my son, before I even knew him.
Smoking is one of the hardest addictions to quit. It’s not easy, but people do it every day. I personally think getting through the nicotine cravings takes a week or two. After that, it’s habit, which is very hard to break. I always tell patients the first 2 weeks feel like you lost your best friend. You will always have cravings, but as time goes on, those cravings will become shorter and more spread out. I always ask my patients, “What do you do when you smoke/inhale a cigarette?” They think and say, “You take a deep breath.” It makes sense then that smoking calms our nerves. I tell people when a craving comes, just take three deep breaths. The craving will go away and you will feel better.
Copyright 2016 by Blue Ridge Pain Managment