Smoking and Back Pain

For years, research has shown a link between smoking and an increased risk for low back pain, intervertebral (spine) disc disease, and inferior patient outcomes following surgery. A new study, published in the December 2012 Journal of Bone and Joint Surgery (JBJS), also found that smokers suffering from spinal disorders and related back pain, reported greater discomfort than patients with spinal disorder who stopped smoking during an eight-month treatment period.

Nearly all adults (80%) will be seen at some time by a physician for back pain or other painful spinal disorders. For some time, smoking has been linked to a number of conditions related to pain, including poor healing of injury, longer episodes of pain after surgery, etc. Given that smoking is a modifiable risk factor for chronic pain conditions, researchers out of the University of Rochester in the United States reviewed the smoking history and monitored the reported pain of more than 5,300 patients with axial (back) or radicular (leg) pain from a spinal disorder, who were treated surgically or non-surgically, over an eight-month period.

At the time of initial care, patients who had never smoked and quit prior reported significantly less back pain than current smokers and those who quit smoking during the study period. Even those who quit smoking during the course of care reported greater improvement in back pain compared to those who continued to smoke. Current smokers reported significantly greater pain in all ratings — worst, current and average weekly pain — when compared with patients who had never smoked.

Other Key Findings:.

  • The mean improvement in pain ratings was clinically significant in nonsmokers.
  • The group that continued smoking during treatment did not report clinically significant improvement in pain.
  • Using the Oswestry Disability Index (the most commonly used research tool to evaluate low back pain), greater mean improvement was observed in patients who had never smoked when compared to current smokers.

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