Do people who smoke have more back pain?

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 Exclusion criteria: not peer-reviewed, not about the epidemiology of back pain and including smoking or exposure to chemicals associated with smoking as a variable, limited to post-surgical failure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.