Nicotine is reported to have
analgesic properties. Patients with
chronic pain who
smoke could therefore, be expected to require less
analgesia than non-smokers because of the possible synergism of the two substances. One hundred healthy patients were studied who had non-radicular
low back pain for greater than three months. Each patient failed
conservative therapies, which consisted of muscle relaxants,
physical therapy and/or
NSAIDS. Our study population consisted of two groups of 50 patients. Each group included: I, cigarette smokers; and II, non-smokers. Each patient received 0-40 mg/24hrs of
hydrocodone as needed for
pain relief for the duration of this four week study. Numeric
pain intensity scores (0-10), mean total
hydrocodone dosing, and quantitative blood
nicotine and
hydrocodone levels were assessed at the beginning and end of this study. Patients kept daily diaries and recorded
pain scores and self
hydrocodone dosing upon awakening, in the afternoon, and at bed time. Parametric and nonparametric statistical analysis was performed using the appropriate test with p < or = 0.05 necessary to reject the null hypothesis There were no differences in demographics between the two groups. Smokers had higher end of study
pain scores and required more
hydrocodone than non-smokers but had significantly lower serum levels of
hydrocodone than non-smokers. The results of this study suggest that cigarette smoking adversely affects serum
hydrocodone levels. Prescribing physicians should be aware that in some cigarette smokers, serum
hydrocodone levels might not be detectible.