The Benefits of Cognitive Behavioral Therapy. Part-2

Smokers respond as well as nonsmokers to cognitive behavioral therapy for the treatment of chronic pain. For example, smokers who completed an intense three-week cognitive behavioral therapy rehabilitative program for patients with severe chronic pain at Mayo Clinic’s Pain Rehabilitation Center experienced equal or better responses than nonsmokers and were as able to successfully taper off opioids, despite greater pain and functional impairment at program entry.1 Similar observations have been made in smokers with fibromyalgia and who were treated with cognitive behavioral therapy at Mayo’s Fibromyalgia and Chronic Fatigue Clinic.

1. Hooten WM, Townsend CO, Bruce BK, Warner DO. The effects of smoking status on opioid tapering among patients with chronic pain. Anesth Analg. 2009;108(1):308-15.
Smokers with chronic pain are more adversely affected by their pain than nonsmokers with chronic pain. Studies of patients presenting to the Mayo Clinic Pain Rehabilitation Center, Outpatient Pain Clinic, Orofacial Pain Clinic, and Fibromyalgia and Chronic Fatigue Clinic consistently show that smokers report greater pain intensity and greater functional impairment than nonsmokers.7-10 In addition, their scores on measures of life interference were worse. For example, smokers with fibromyalgia missed more days of work; reported worse sleep, greater anxiety, and depression; and had more pain, stiffness, and fatigue than nonsmokers with fibromyalgia.


Because nicotine has analgesic properties and smoking a cigarette can blunt pain perception,11 the higher prevalence and increased severity of chronic pain in smokers as compared with nonsmokers may seem surprising. Researchers are exploring this apparent paradox. They have found that nicotine-habituated animals undergoing nicotine withdrawal demonstrate increased sensitivity to pain stimuli.12 They have also found that when human smokers are deprived of nicotine, they perceive pain stimuli earlier and have reduced tolerance for pain.13,14 Thus, some postulate that nicotine withdrawal could increase a smoker’s perception of pain and even the intensity of chronic pain.