Smoking cessation either prior to treatment or during the course of care was related to significant improvements in pain – a result that underlines the need for structured stop-smoking programs among the legions of patients who experience back pain due to degenerative disease, deformity, or musculoskeletal problems, said Caleb Behrend, M.D., chief resident in the Department of Orthopaedics and Rehabilitation at URMC.
Glenn R. Rechtine, M.D., a nationally recognized spinal surgeon and adjunct faculty at URMC, led the study, which was published in the Journal of Bone and Joint Surgery.
“We found that people who stopped smoking had meaningful benefit by reduction of their pain,” said Behrend. “The pain improvement is in addition to all the other benefits you gain from quitting.”
The relationship between pain and smoking is complex and full of contradictions. Nicotine has analgesic properties, for example, and yet clinical evidence shows that smokers are at higher risk for developing back pain and other chronic pain disorders, according to the American Society of Anesthesiologists.
Scientists already know that nicotine interacts with a family of proteins (nAChR), which have a key role in the central, and peripheral nervous system, and control anxiety and pain. Prolonged exposure to cigarettes upsets the function of these cells and eventually changes the way pain is processed, as well as impairing oxygen delivery to tissues, predisposing a person to bone and joint disorders such as osteoporosis, and inducing inflammation and depression. Smokers with spinal conditions also tend to have persistently more intense pain and more long-term disability.
The URMC study noted a daunting fact: Nearly all people will experience back pain at some point in their lives and many will seek medical care. And because the socioeconomic impact of spinal disorders (cost of care and lost productivity for patients) is so great, researchers wanted to find out if improvements in pain could be achieved with a cost-effective intervention such as smoking cessation.
Researchers reviewed a prospectively maintained database of 5,333 patients, who completed questionnaires about pain at the initial doctors’ visit and at the time of discharge from care. Patients were treated with surgery, or with physical therapy, injections, over-the-counter medications, and home exercise programs. Physicians counseled all smokers to quit, and patients were referred to a smoking cessation hotline.
Of the 5,333 people, those who had never smoked or had quit some time ago reported less pain than smokers or those who had just quit. By the end of the follow-up period, the people who had recently quit or who quit during treatment showed significant improvements in pain. People who continued to smoke during treatment had no improvement in pain on all scales.
Behrend noted that younger people tended to comprise the group of current smokers and those who only decided to quit during treatment; this is consistent with other studies showing that smoking is associated with degenerative spine disease at a younger age. Older patients tended to comprise the group who had never smoked or quit long ago.
The rate of smoking cessation was 22 percent, and research shows that up to 36 percent of patients with painful spinal disorders are able to quit with help from a structured program. A grant from the Southwestern Medical Foundation was used to create and maintain the patient database.
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