How early does nicotine dependence start?
The natural course of cigarette use has traditionally been thought to progress through 5 stages, ending with nicotine-dependent smoking. Gervais and colleagues describe the sequence and timing of 12 milestones (6 related to cigarette use and 6 to symptoms of nicotine dependence) among grade 7 students. They found that symptoms of nicotine dependence can manifest long before regular smoking, even after the first puff in some cases. In a related commentary, Klein discusses the challenges in helping young smokers quit and the need for stronger public health efforts to keep youth from starting. See pages 255 and 262 Managing neuropathic pain in primary care Neuropathic pain, caused by various nerve disorders, is difficult to control and is personally devastating to the people who have it. Gilron and colleagues review the clinical presentation, pathophysiology and current treatments available. They also provide a practical approach to the management of neuropathic pain in primary care. See
