Are Neuropathy Patients Likely To Be Heavy Smokers Or Vice Versa

Today's post from medscape.com (see link below) seems not to be sure on which side of the fence it sits. The statistics show that far more people with nerve pain smoke heavily than those with nociceptive pain (pain caused by injury and external factors). The article seems to suggest a link between the light analgesic qualities of tobacco/nicotine and that pattern - as if to say that nerve pain patients use cigarettes as a mild pain killer. Yet it is patently clear that the harmful effects of nicotine far outweigh the benefits so it is doubtful that patients consciously make the choice to smoke to chemically ease their pain. Is it not more likely that people with nerve pain are so stressed out by the nature of their symptoms that cigarettes perform their traditional role of 'comforter' in much the same way that over-eating and over-drinking do? The vast majority of neuropathy articles also point to smoking as a cause of neuropathy, so where does that leave us? Whatever the truth, the fact remains that there are more heavy smokers among neuropathy sufferers than those with other forms of pain - the question remains as to why!

People With Neuropathic Pain Twice as Likely to Smoke Cigarettes
Stephanie Doyle February 18, 2008

February 18, 2008 (Kissimmee, Florida) — Results of a new study suggest that people with chronic neuropathic pain are twice as likely to smoke cigarettes as those who have chronic nociceptive pain.

The study, led by Toby N. Weingarten, MD, from the Mayo Clinic College of Medicine in Rochester, Minnesota, showed that of the 205 smokers who participated in the study, 62% had been diagnosed with neuropathic pain, whereas only 33% had been diagnosed with nociceptive pain.

"To us that is surprising — we were surprised that smoking would influence what type of pain smokers had," Dr. Weingarten told Medscape Neurology and Neurosurgery.

The results were presented here at the American Academy of Pain Medicine 24th Annual Meeting.

Poor Response to Medications

Nociceptive pain is the common discomfort experienced as a result of injury, such as a broken bone or appendicitis. Neuropathic pain is associated with injury to a nerve or the central nervous system. Such injuries can give rise to paresthesias, such as numbness, tingling, or electrical sensations.

Nociceptive pain typically responds to anti-inflammatory agents and opiates, whereas neuropathic pain often responds poorly to such medications.

In the current study, the authors aimed to determine the percentage of community subjects with chronic neuropathic pain who smoke. Subjects were recruited from a large population-based study to assess the prevalence of chronic pain.

These adults had self-reported neuropathic pain, were identified from patient charts as having neuropathic pain, or had a positive score on the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), a tool designed to identify patients with neuropathic pain. They also self-reported current smoking status.

The percentage of participants confirmed as having neuropathic pain by clinical assessment who also smoked was 21%, compared with 13% in the overall sample (P = .009). Smoking was twice as common (62% vs 33%) in subjects who were diagnosed by clinical assessment as having neuropathic pain as nociceptive pain.

The percentages of those who smoked varied by positivity on screening tests for neuropathic pain: 18% for a positive S-LANSS score, 12% with self-reported neuropathic pain, and 8% of those with select ICD-9-CM codes from patient charts.

"The possible physiologic relation between smoking and development of chronic neuropathic pain deserves further evaluation," the authors conclude.

Not Advocating Smoking

"This study is intriguing," said Todd Sitzman, MD, MPH, president of the American Academy of Pain Medicine. "Clinical studies have shown a modest analgesic effect from nicotine. Although there is an association between nicotine and neuropathic pain, there is no direct causative effect."

However, Dr. Sitzman, who was not involved with the study, told Medscape Neurology and Neurosurgery: "I caution advocating smoking as a perceived treatment for neuropathic pain, since it is clear that the adverse risks of smoking outweigh any potential benefit."

Funding was provided by AstraZeneca and the National Institutes of Health. Dr. Weingarten has disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 24th Annual Meeting: Abstract 100.

Medscape Medical News © 2008

http://www.medscape.com/viewarticle/570347

WOMEN WITH PTSD MORE LIKELY TO HAVE FOOD ADDICTION

Women who have the largest number of post-traumatic stress disorder symptoms are almost three times more likely to develop an addiction to food, a new study suggests.

The findings don’t prove a direct link between PTSD and women overeating or becoming addicted to food. And it’s also possible that certain women are prone to food addiction and experiencing trauma, PTSD, or both.

Still, the research seems to add to existing evidence connecting PTSD to overeating and obesity, although the overall risk is fairly low, the researchers from the University of Minnesota said.

The findings can be helpful, said the study’s lead author, Susan Mason, an assistant professor with the university’s division of epidemiology and community health. “If clinicians providing mental health care are aware that PTSD is sometimes accompanied by problematic eating behaviors, then they may be able to offer better and more tailored care to their patients,” she said.

PTSD is an anxiety disorder that develops in some people after they experience a horrific event, like a natural disaster, violence or warfare. Those with PTSD may become endlessly vigilant, have a difficult-to- impossible time relaxing, and can develop flashbacks, nightmares and severe anxiety.

Previous research has linked PTSD to higher rates of obesity and being underweight, Mason said, along with addiction problems. It’s difficult for researchers to figure out exactly what’s going on, however, because they can’t use the gold standard of research, a clinical trial, to examine a possible connection. It would be unethical — and probably impossible — to randomly assign some people to develop PTSD and then compare them to healthy people.

In the new study, researchers tried to get a handle on possible connections between PTSD and food addiction.

Food addiction is defined as a kind of psychological dependence on food, with symptoms like other kinds of addictions. For instance, physical withdrawal if those with the disorder stop eating certain foods, using food to make them feel better and eating when they don’t need to.

Mason said she wasn’t aware of research pinpointing how many people suffer from food addiction.

The researchers examined the results of Nurses’ Health Study II surveys of more than 49,400 female nurses in the United States in 2008 and 2009. The women joined the study in 1989 when they were 25 to 42 years old.

According to Mason, the researchers found that 6 percent of the one-third of women who had no signs of PTSD showed signs of food addiction. Of the 10 percent of women who had the most symptoms — 6 to 7 on a 7-symptom PTSD screening questionnaire — nearly 18 percent had a food addiction.

The researchers noted two things: Nurses reported their most common trauma experience was treating individuals with traumatic injuries, and early onset of symptoms predicted a higher prevalence of food addiction.

Why do these numbers matter? “It is a big deal if a substantial proportion of women are feeling highly distressed or feel that their functioning is being undermined by their relationship with food,” Mason said.

Still, she said it’s not clear how all this is connected to obesity. The nurses in the study who seem to be addicted to food “are substantially heavier than women who do not meet those criteria, but we don’t yet know whether the food addiction causes obesity, or the other way around, or if the two things are both caused by some underlying factor we don’t know about.”

Dr. Timothy Brewerton, executive medical director with The Hearth Center for Eating Disorders in Columbia, S.C., praised the research. “This study represents a major advance in validating the concept of food addiction, and in linking food addiction with trauma and PTSD,” he said.

He noted that the study adds support for the idea that food addiction is real — “there are a lot of naysayers in the eating disorders community in regard to the existence of food addiction”– and suggests that trauma and PTSD could be a cause. “The greater the number of PTSD symptoms, the greater the probability of food addiction,” he said.

As for future research, Mason said researchers want to look at larger groups of people to see if the connection holds up.

The study appears in the Sept. 17 issue of JAMA Psychiatry.