Pain medicine literature supports smoking as a predictor for pain conditions, such as low back pain and disk diseases (Am J Med2010;123:87.e7-35;Eur J Epidemiol2001;17:643-651). New research now demonstrates that smoking cessation has a causal relationship with improvements in pain in patients with spinal disorders and axial and radicular pain. What’s more, the study results were counter to the investigators’ hypothesis that older patients would be less successful in smoking cessation efforts, and that quitting smoking would have less effect on their pain than in younger patients.
The study population was individuals undergoing treatment for spinal disorders and reporting severe axial or radicular pain (N=6,779). After assessing for pain (using a self-reported visual analog scale [VAS]), type of treatment, age, weight, sex, smoking history and depression history, the researchers determined that 23.9% of individuals aged 55 years and under and 8.9% of those over the age of 55 had a history of smoking. Younger patients were slightly more likely to have quit smoking (26.1%) compared with those over age 55 (25%). Mean treatment duration was eight months.
The researchers found that individual who smoked and quit demonstrated greater improvements in pain symptoms than those who continued to smoke. Individuals who did not quit smoking did not report any clinically significant improvements in pain symptoms as a group. Current smokers had more severe pain than individuals who never smoked, regardless of age, and had significantly less pain improvement over the course of treatment (P<0.001). Patients who underwent successful smoking cessation during treatment had greater improvements in VAS scores for both worst pain and current pain (P=0.009 and P=0.01, respectively).
“Mean improvement in reported pain over the course of treatment was significantly different in nonsmokers and current smokers in both age groups,” wrote the investigators. They found no differences in smoking cessation rates or reductions in pain symptoms in patients who quit smoking between the two age groups, and called for smoking cessation efforts in pain patients.
The study results are in agreement with previous research showing that quitting smoking was linked to better spinal procedure fusion rates (Spine2000;25:2608–2615).
The researchers presented the findings at the 2013 annual meeting of the American Academy of Orthopaedic Surgeons.
Based on a press release from the AAOS.