The possible relationship between tobacco smoking and pain is complex and research on this subject often has been confusing. A new study, widely reported in news media, claims that smoking cessation can be important for aiding patients with back pain disorders. While this seems sensible, the outcomes of the study were not as strong and unambiguous as news reports implied.
Caleb Behrend, MD, at the University of Rochester, New York, and colleagues conducted a cross-sectional study to examine the effects of tobacco smoking versus smoking cessation on pain and disability in 5,333 patients with painful spinal disorders. Data for the study came from a medical records database at two academic hospital centers where the selected patients were receiving care for back pain disorders, either focused on the spine (axial) or also involving the legs (radicular).
The researchers extracted data regarding smoking history and patient assessments of pain on 4 visual analog scales (VAS) during the course of care — evaluating
(1) worst,
(2) least,
(3) weekly average, and
(4) current pain.
During the study, patients were treated with physical therapy, over-the-counter pain relievers, a home exercise program, injections, and/or surgery. The average duration of follow-up was 8 months.
(1) worst,
(2) least,
(3) weekly average, and
(4) current pain.
During the study, patients were treated with physical therapy, over-the-counter pain relievers, a home exercise program, injections, and/or surgery. The average duration of follow-up was 8 months.
Given the strong association between improved patient-reported pain and smoking cessation, the researchers believe that their data support the need for smoking cessation programs for all patients with painful spinal disorders.
Comment:
Behrend et al. concede that a weakness of their study was in not being able to assess the types of medical interventions for pain in the various groups, or the influences of individual patient factors (other than smoking). For example, is it possible that smokers were provided a different range of therapies for their back-pain conditions than non-smokers? Or, that more non-smokers had generally healthier lifestyles — eg, diet, exercise, etc. — which may have affected their outcomes?
by
B.Akshaya Srikanth
Hyderabad, India
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