Double Crush Syndrome and Smoking: Part 2

A couple weeks ago I wrote an article about the link between Double Crush Syndrome and smoking. I received some feedback that made me want to return to a particular subject. In case you missed it, due to the link between smoking and decreased oxygenation of various body tissues, smoking (and similar co-morbidities) can affect neural conduction and, thus, contribute to Double Crush Syndrome. The topic that was brought up primarily surrounded medical marijuana.

Medical marijuana is used by some for pain relief, among other reasons. So what about the discrepancy between these uses and potential contribution to Double Crush Syndrome? With the progress in pain science, one thing that we should understand at this point is the power of the mind. I've spoken before about how placebo can impact a patient, due to patient beliefs. The same can apply to any treatment. Getting back to medical marijuana, there will be some patients that have success with the drug lowering the sensitivity of the nervous system and decreasing pain. For some people it won't work. As ambiguous as that sounds, we should still try and at least use evidence to guide our decisions. We should remember the physiological response of our bodies to smoking. With smoking, one of the body's responses involves vasoconstriction and increased blood pressure. This results in decreased oxygenation of the tissues throughout the body and potential neural tension. We must remember, however, that there are nerves that descend from the CNS that can alter the sensitivity of the afferent nerves. So if someone is believing they will have a positive effect from smoking, they may benefit from not eliminating it immediately.

So how do we handle this as clinicians? On one hand, we know there is a link between smoking and cancer, so we should educate our patients on the dangers of continuing smoking. On the other hand, if we tell a patient to stop smoking immediately, they may ignore any advice we give and fail to improve. What I would recommend is educate your patients on the physiological effects of smoking and the benefits of quitting. Do not demand your patients stop, but encourage weaning off of it to not only improve their pain, but their health overall. The patient may have a period where they get pain relief from smoking or marijuana, but either offer alternatives to stress/pain relief or use a period of pain relief to progress the patient beyond the need for smoking.

-Chris

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