Perioperative Nicotine Withdrawal Amplifies Pain and Opioid Demand

This narrative review synthesizes animal and human data indicating that acute nicotine abstinence produces measurable hyperalgesia relevant to perioperative and palliative pain management, and positions transdermal nicotine replacement as a mechanistically supported intervention.

nicotinenicotine replacement therapytransdermal patchsmoking cessationhyperalgesianicotine withdrawalperioperative painopioid requirementnarrative reviewPainPalliative Care Pain / Palliative Care

Background Information

Nicotine withdrawal heightens pain, increasing opioid needs post-surgery.

Smoking cessation can lead to increased postoperative pain and opioid use due to heightened pain sensitivity, influencing perioperative pain management strategies. Nicotine withdrawal lowers pain thresholds, increasing sensitivity and opioid requirements. Nicotine replacement therapy mitigates withdrawal-induced hyperalgesia. The study highlights the need for integrating nicotine replacement therapy into perioperative care for smoking cessation patients, though more clinical data is needed for chronic pain contexts. Nicotine withdrawal intensifies pain, managed by nicotine replacement therapy to improve postoperative outcomes.

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Authors: Hu SS, Zhang CF, Lkhagvasuren B, Wang D

Citation: Hu SS, Zhang CF, Lkhagvasuren B, et al. Smoking Abstinence Elicits Hyperalgesia: Neural Mechanism, Clinical Implications, and Pharmacological Managements. CNS neuroscience & therapeutics. 2026;32(9):e71132. doi:10.1002/cns.71132

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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