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It sensitizes the peripheral nervous system, and nociceptive thresholds in smokers (and those exposed to secondhand smoke) tend to decrease (compared to non-smokers), increasing pain reactivity and perceived pain (learn more about pain sensitization)

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Thats how powerful this drug is. Smoking rates have been on the decline in the US, but some experts such as Presser and UCSFs Glantz point to the rise of e-cigarettes as representing a new era of public health concern