Detox-Withdrawal and Pain in Substance Use Disorders

Emerging research reveals that people with substance use disorders (SUDs) may have increased pain sensitivity/hyperalgesia when withdrawing from addictive substances. Understanding how drug withdrawal affects pain is a major area of basic/clinical investigation.

A December 2025 neuroimaging study by Wei and colleagues offered detailed evidence linking short-term smoking abstinence to increased pain perception. This study enrolled 60 men preparing for surgery, assigning them to the abstinent smoker group or the nonsmoker group. Because smokers preparing for elective surgery are typically instructed to quit on hospital admission, the researchers studied individuals with a short period of cessation. The researchers demonstrated that newly abstinent smokers had significantly higher pain than nonsmokers, as well as substantially higher postoperative opioid needs for pain control. These findings confirmed earlier work from the same group showing reduced tolerance to electrical pain stimuli and greater narcotic use after surgery.

Nicotine withdrawal leads not only to increased pain perception but also to increased emotional awareness of painful stimuli. This explains why abstinent smokers report more subjective pain and need higher postoperative analgesic doses. Surgical teams often struggle with postoperative pain management, and this new evidence explains why their analgesic needs may exceed expectations. Nicotine replacement therapy (NRT) might mitigate withdrawal-hyperalgesia, and preliminary findings do show improved pain thresholds.

This hyperalgesia appears pronounced during the early weeks of abstinence and slowly normalizes over three months. The short preoperative nicotine detox and abstinence period that is commonly advised for surgical safety may paradoxically increase short-term pain sensitivity and

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