ChiroACCESS Article



Adult and Youth Smoking Predicts Low Back Pain



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March 31, 2011

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“The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers. Age and sex were found to be effect modifiers (P < 0.0001)”. 


CigarettesResearch from the last year continues to link smoking with numerous types of musculoskeletal pathologies that are commonly seen in chiropractic practice.  These studies punctuate the high association between smoking and low back pain, especially with individuals that begin smoking in their teens.

A large Finish cohort study examined lifestyle (smoking, obesity and exercise levels) as it relates to low back pain (LBP) or sciatica.  Among males, smoking was associated with first time hospitalization for LBP and with second time surgical hospitalization.  Another review provided a summary of the studies that link smoking to both LBP and adverse LBP surgical outcomes.  That study also noted the strong association between smoking and osteoporosis, which is related to a number of osseous pathologies including LBP.  A third 2010 study concluded that “Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.”  An Australian study investigated the factors associated with the risk of LBP among female nursing students.  Again, smoking was identified as one of the significant lifestyle risks. 

Other smoking related articles on this site can be found here and here.

Note:  These mini-reviews are designed as updates and direct the reader to the full text of current research.  The abstracts presented here are no substitute for reading and critically reviewing the full text of the original research.  Where permitted we will direct the reader to that full text.

Sports, Smoking, and Overweight During Adolescence as Predictors of Sciatica in Adulthood: A 28-Year Follow-up Study of a Birth Cohort.

Am J Epidemiol. 2011 Mar 10. [Epub ahead of print]

Rivinoja AE, Paananen MV, Taimela SP, Solovieva S, Okuloff A, Zitting P, Jarvelin MR, Leino-Arjas P, Karppinen JI.

Abstract

Lifestyle factors such as smoking, obesity, and level of physical activity predict low back pain (LBP) and sciatica. The authors investigated whether participating in sports, smoking, and being overweight or obese at 14 years of age predicted hospitalizations due to LBP or sciatica in adulthood. In 1980, at the age of 14 years, a total of 11,399 members of the 1966 Northern Finland Birth Cohort returned the postal questionnaire. Patients from the 1966 Northern Finland Birth Cohort who were hospitalized because of LBP or sciatica were followed to the end of 2008 through the Finnish Hospital Discharge Register. Data were analyzed using Cox's proportional hazards multistate model with the Markov clock forward time scale. During follow-up, 119 females (2.7%) and 254 males (5.6%) had been hospitalized at least once because of LBP or sciatica. Among females, overweight was associated with an increased risk of second-time hospitalization for surgical treatment for sciatica (hazard ratio = 7.1, 95% confidence interval: 1.5, 34.4). Among males, smoking was associated with an increased risk of first-time nonsurgical hospitalization (hazard ratio = 1.8, 95% confidence interval: 1.2, 2.7) and second-time surgical hospitalization (hazard ratio = 3.2, 95% confidence interval: 1.2, 8.2). The authors found potentially modifiable risk factors in adolescence that predicted hospital treatments for low back disorders during adolescence and young adulthood.

[Does Smoking Correlate with Low Back Pain and the Outcome of Spinal Surgery?] 

[Article in German]

Z Orthop Unfall. 2011 Feb 21. [Epub ahead of print]

Stienen MN, Richter H, Prochnow N, Schnakenburg LF, Gautschi OP.
Klinik für Neurochirurgie, Kantonsspital St. Gallen, Schweiz.

BACKGROUND: For a long time, orthopaedic surgeons have suspected an influence of smoking on several musculoskeletal diseases. The aim of this review is to discuss the influence of smoking on low back pain (LBP) and the outcome of spinal surgery. LBP is a highly prevalent disease and plays an important economic role, as it is associated with high direct and indirect health-care costs. In order to be successful in prevention, risk factors for LBP must be identified.

METHODS: A review of the literature (using PubMed with the search terms: smoking, low back pain and pathophysiology) was performed. Of the search results, 196 publications from peer-reviewed journals were analysed (including three randomised clinical trials, 134 clinical, 28 experimental articles and 31 reviews [including one Cochrane Database review and five systematic reviews]). Additionally, 11 official publications of the US Department of Health and Human Services, the International Agency for Research on Cancer (France) and the "Deutsches Krebsforschungszentrum" were used.

RESULTS: While the evidence level for severe adverse effects of smoking on osteoporosis is good, many studies performed on LBP describe a statistical association, but are not useful to detect a causal link between smoking and lumbar disease. However, with plausible pathophysiological mechanisms and an overwhelming number of studies identifying a correlation it is suggested that smoking is likely to contribute to LBP and affects spinal surgery adversely. As for all diseases with multifactorial (including psychosocial) aetiology, it proves difficult to distract the confounding factors for analysis.

CONCLUSION: A high number of studies performed to identify an association between smoking and LBP have not led to a final conclusion. But still, on the basis of the current knowledge, a negative contribution of smoking on LBP and spinal surgery seems probable.

The association between smoking and low back pain: a meta-analysis. [Link]

Am J Med. 2010 Jan;123(1):87.e7-35.

Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E.
Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland. rahman.shiri@ttl.fi

OBJECTIVE: To assess the association between smoking and low back pain with meta-analysis.

METHODS: We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses.

RESULTS: In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32).

CONCLUSIONS: Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.

Identification of modifiable personal factors that predict new-onset low back pain: a prospective study of female nursing students. [Link]

Clin J Pain. 2010 May;26(4):275-83.

Mitchell T, O'Sullivan PB, Burnett A, Straker L, Smith A, Thornton J, Rudd CJ.
School of Physiotherapy, Curtin University of Technology, Western Australia. ditim@ozemail.com.au

OBJECTIVES: Prevention of occupational low back pain (LBP) in nurses is a research priority. Recent research suggests intervening before commencing nursing employment is ideal; however, identification of modifiable risk factors is required. The objective of this study was to investigate modifiable personal characteristics that predicted new-onset LBP in nursing students.

METHODS: This prospective study was conducted on female nursing students (n=117) without LBP at baseline to predict new-onset LBP (an episode of significant LBP during the follow-up period). At the 12-month follow-up, participants with (n=31) and without new-onset LBP (n=76) were compared across baseline social or lifestyle, psychologic (distress, back pain beliefs, coping strategies, and catastrophising), and physical (spinal postures and spinal kinematics in functional tasks, leg and back muscle endurance, spinal repositioning error, and cardiovascular fitness) characteristics.

RESULTS: Participants response rate at follow-up was excellent (91%). After controlling for earlier LBP, age, and BMI, regression analysis showed that modifiable social or lifestyle, psychologic and physical characteristics (namely, smoking, increased physical activity, higher stress, reduced back muscle endurance, greater posterior pelvic rotation in slump sitting, and more accurate spinal repositioning in sitting) were significant and independent predictors of new-onset LBP at follow-up. Inclusion of these factors in multivariate logistic regression analysis, with significant new-onset LBP as the outcome, resulted in a substantial model R of 0.45.

DISCUSSION: Modifiable personal characteristics across multiple domains are associated with new-onset LBP in female nursing students. These findings may have implications for the development of prevention and management interventions for LBP in nurses.

Risk factors for low back pain and its relation with pain related disability and depression in a Turkish sample. [Link]

Turk Neurosurg. 2009 Oct;19(4):327-32.

Tucer B, Yalcin BM, Ozturk A, Mazicioglu MM, Yilmaz Y, Kaya M.
Erciyes University, School of Medicine, Neurosurgery Department, Kayseri, Turkey.

AIM: To investigate the relation of depression and pain-related disability associated with Low Back Pain (LBP).

MATERIAL AND METHODS: The Quebec Back Pain Disability Scale, Visual Analogue Scale (VAS) and Zung Depression Scale were sent to 3800 randomly select adults in Kayseri, Turkey. The demographic characteristics of the participants (Socioeconomic status, age etc) and low back pain (frequency, intensity, duration) features together with pain-related factors were investigated in responding participants. The participants who had self-reported LBP during the study period were accepted as the study group.

RESULTS: 807 (37.1%) of the participants reported that they had low back pain at the time of interview. The study group had a score of 52.91+/-24.20 mm for VAS, 52.30+/-10.67 for the Zung Depression Scale and 24.53+/-17.22 for the Quebec Back Pain Disability Scale. Age, female gender, smoking ( > 20 cigarettes per day), low socioeconomical status and living in a rural habitat were found to be associated with low back pain. Depression (P= 0.017) and disability (P= 0.002) were found to be independent risk factors for VAS. CONCLUSION: Determination of the frequency and intensity of low back pain and related factors is needed for the prevention and management of pain. Mood disorders and self reported restriction in daily activities should be screened in patients with low back pain.

Cigarette smoking and chronic low back pain in the adult population. [Link]

Clin Invest Med. 2009 Oct 1;32(5):E360-7.

Alkherayf F, Agbi C.
Department of Surgery, the Ottawa Hospital, Ottawa, Ontario, Canada. Alkherayf@hotmail.com

PURPOSE: Chronic low back pain (LBP) is one of the main causes of disability in the community. Although there have been studies suggesting an association between smoking and LBP, these studies were limited by the small numbers of patients, and they did not control for confounders. The objective of this study was to determine whether cigarette smoking is associated with an increased risk of chronic LBP among adults.

METHODS: Using Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians aged 20 to 59 yr were identified. Self-reported chronic LBP status, smoking habits, sex, age, height, weight, level of activity and level of education were identified as well. Back pain secondary to fibromyalgia was excluded. Multivariate logistic regression analysis was used to detect effect modification and to adjust for covariates. Design effects associated with complex survey design were taken into consideration.

RESULTS: The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers. Age and sex were found to be effect modifiers (P < 0.0001), and the relationship between smoking and chronic LBP risk was dependent on sex and age. The association between daily smoking and the risk of chronic LBP was stronger among younger individuals. Occasional smoking slightly increased the odds of having chronic LBP.

CONCLUSION: Daily smoking increases the risk of LBP among young adults, and this effect seems to be dose-dependent. Back pain treatment programs may benefit from integrating smoking habit modification. Further research is required to develop effective prevention strategies.
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