Online Program

Do people who smoke have more back pain?

Monday, November 4, 2013 : 3:00 p.m. - 3:10 p.m.

Bart Green, DC, MSEd, Department of Physical and Occupational Therapy, Chiropractic Services, and Sports Medicine, Naval Medical Center San Diego, San Diego, CA
Claire Johnson, DC, MSEd, PhD, Editor, Professor, National University of Health Sciences, Escondido, CA
Background: Smoking is a common but harmful health behavior amongst Americans. Back pain is a musculoskeletal problem with a lifetime prevalence of 80%. This study reviewed the literature to determine if there is evidence to support an exposure/outcome relationship between smoking and back pain. Methods: PubMed, ProQuest and the Networked Digital Library of Theses and Dissertations were searched from the earliest month and year available through December 2012. The search terms were “smoking” and “back pain”. References of each article were scoured for additional papers. Inclusion criteria: cohort, case control, cross-sectional, or meta-analysis designs. Exclusion criteria: not peer-reviewed, not about the epidemiology of back pain and including smoking or exposure to chemicals associated with smoking as a variable, limited to post-surgical failure rates, and 'wrong topic'. Results: There were 555 citations in the initial search. After cursory review, 215 full papers were obtained for further assessment. The overwhelming majority of research papers support an exposure/outcome association between smoking and back pain with odds ratios ranging from approximately 1.2 – 4.4. Current smokers have a higher prevalence of back pain. Former smokers have a higher prevalence of back pain than people who have never smoked, but a lower prevalence than people who are current smokers. Conclusion: Smokers had a higher prevalence of back pain, which supports an exposure/outcome association. A lack of conformity in reporting studies was a limitation of this literature review but points to the importance of using a standardized reporting methodology, such as STROBE, in future research.

Learning Areas:

Chronic disease management and prevention

Learning Objectives:
Identify smoking as a potential variable in the cause of back pain. Discuss the magnitude of an exposure/outcome association between smoking and back pain. Discuss the importance of standardized reporting methodologies for epidemiologic studies.

Keyword(s): Smoking, Chiropractic

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have met all 3 of the criteria for authorship: 1) substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; 2) drafting the abstract and revising it critically for important intellectual content; and 3) final approval of the version to be submitted. I am working on this research as part of my dissertation for a PhD in public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.