Assessment of pain in adolescents: Influence of gender, smoking status and tobacco abstinence

Abstract

Purpose: We examined sex differences between smokers and nonsmokers in pain threshold, tolerance, and intensity and the effect of pain on cardiovascular measures, withdrawal, and craving during acute smoking abstinence.

Methods: Ninety-six (53 smokers, 43 nonsmokers) adolescents completed the Cold Pressor Task (CPT) to assess pain responses after minimal (1h) and 42-hour smoking deprivation. Vital signs and craving were assessed before and after CPT completion.

Results: Smokers, compared to nonsmokers, had significantly lower pain tolerance (p<0.01) and pain threshold (p<0.001). Female smokers had significantly lower pain tolerance prior to, and following, 42-hour deprivation compared to male smokers (p's<0.01), male nonsmokers (p's<0.01), and female nonsmokers (p's<0.001), while male smokers demonstrated significantly decreased pain tolerance following 42-hour deprivation (p<0.05). Additionally, during minimal deprivation, at time of hand removal, female smokers had higher pain intensity compared to female nonsmokers (p<0.05) and male smokers (p<0.01). Withdrawal was not significantly correlated with any CPT measures or subjective pain during or following minimal deprivation or acute abstinence. Craving was associated with pain 15s after hand submersion (p=0.007) at 42-hour deprivation.

Conclusions: Smokers had a lower pain threshold than non-smokers, with female smokers demonstrating lower pain tolerance during minimal deprivation than all comparison groups, and, continuing to have diminished pain tolerance compared to female nonsmokers following 42h of abstinence. Male smokers demonstrated tobacco-deprivation-induced reductions in pain tolerance. Further study of pain-related factors that may contribute to relapse and maintenance of smoking behaviors, and mechanisms of these relationships among adolescent smokers is warranted.

Keywords: Abstinence; Adolescents; Nicotine; Pain; Smoking; Tobacco.

Figure 1

Pain tolerance (A) and Pain rating (B) in smokers and nonsmokers during minimal deprivation and following 42 hours of deprivation from tobacco. *A: Pain Tolerance (p<0.05): Female smokers<Female nonsmokers, Male smokers, Male nonsmokers Male smokers-42 hr<Minimal deprivation B: Pain Intensity (p<0.05): Minimal deprivation: Female smokers>Female nonsmokers, Male smokers Male smokers: 42 hr>Minimal deprivation

Figure 2

Systolic (A & B) and Diastolic (C& D) blood pressure and pulse rate (E & F) around CPT. Panels A, C and E were obtained during the CPT conducted while smokers were minimally deprived from tobacco and B, D and F were obtained during the CPT conducted following 42 hours of tobacco deprivation. *C: Nonsmokers>Smokers (p<0.01) D: Smokers>Nonsmokers (p<0.01) E: Smokers>Nonsmokers (p<0.01)

Figure 3

Systolic blood pressure in male and female smokers and nonsmokers during the Cold Pressor task (CPT) conducted when smokers were minimally deprived (A) or in 42 hours of deprivation (B). *B: Female smokersp<0.01), Male nonsmokers (p<0.01), Female nonsmokers (p<0.05)