Smoking Associated With Worse Back Pain

Written by admin on January 30, 2013 – 10:09 am -

Medscape Medical News
Smoking Associated With Worse Back Pain
Joe Barber Jr, PhD

Patients with spinal disorders who quit smoking may experience substantial improvements in back pain, according to the findings of an analysis of a prospectively maintained database.

Caleb Behrend, MD, from the University of Rochester Medical Center in New York, and colleagues present their findings in an article published in the December issue of the Journal of Bone & Joint Surgery.

The authors mention that smoking has been identified as a modifiable risk factor for chronic pain disorders. “Furthermore, with regard to chronic pain disorders, smokers have reported an increased magnitude of pain when compared with nonsmokers,” the authors write. “Glassman et al. found that smoking cessation in patients undergoing spinal arthrodesis was associated with increased patient satisfaction, fusion rates, and return to work.”

In the study, the authors reviewed questionnaires for 5333 patients completed at the time of entry into care and at the time of the latest follow-up. Patient-reported pain scores were assessed using a visual analog scale (VAS).

Compared with never-smokers, current smokers reported significantly greater pain scores at the latest follow-up (mean VAS score, 4.49 [95% confidence interval (CI), 4.15 - 4.84] vs 3.59 [95% CI, 3.49 - 3.70]; P < .001).

Patients who quit smoking reported significantly greater improvements compared with current smokers in worst (mean VAS score, −1.56 [95% CI, −1.94 to −1.17] vs −0.70 [95% CI, −0.90 to −0.51]; P = .013), current (mean VAS score, −1.07 [95% CI, −1.44 to −0.70] vs −0.46 [95% CI, −0.66 to −0.28; P < .05), and average (mean VAS score, −1.23 [95% CI, −1.56 to −0.86] vs −0.46 [95% CI, −0.66 to −0.27]; P = .024) weekly pain.

In addition, nearly 2-fold more patients who quit smoking reported a more than 30% decrease in worst pain than current smokers (32.0% vs 16.6%), and never-smokers reported a greater mean improvement in disability as determined by the Oswestry Disability index than current smokers (−7.3 points [95% CI, −8.1 to −6.5 points] vs −4.6 [95% CI, −5.6 to −3.6]).

According to the authors, limitations of the study include their inability to capture the effects of all possible factors that may influence pain and determine when patients stopped smoking or experienced improvements in pain.

They conclude that smoking cessation programs are needed to improve chronic pain among patients with spinal conditions. "The present study supports the need for smoking cessation programs for patients with axial or radicular pain of spinal etiology, given a strong association between improved patient-reported pain and smoking cessation," the authors write.

Asked for independent comment, David O. Werner, MD, from the Mayo Clinic, Rochester, Minnesota, agreed with the authors' conclusion. "This suggests that tobacco use interventions should be an integral part of pain treatment," Dr. Werner told Medscape Medical News. "Given the tremendous health benefits of quitting, clinicians should take every opportunity to help every smoker quit, but if pain is improved, this makes the issue even more urgent for the pain physician."

One coauthor received a grant from the Southwestern Foundation. One coauthor received grants or has grants pending with FOT and Goldstein. The other authors and the commentator have disclosed no relevant financial relationships.

For more information on this topic click below- J Bone Joint Surg Am. 2012;94:2161-2166.

Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care

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Cause of Ache in Tailbone when Sitting

Written by admin on November 27, 2012 – 10:34 am -

Have you ever wondered why your tailbone may ache? For more information on possible causes of pain at/ near your tailbone please visit Cause of Ache in Tailbone when Sitting

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Can Sore Neck Muscles from Weight Lifting Cause Headache?

Written by admin on November 20, 2012 – 9:40 am -

“Not only can sore neck muscles from working out with weights cause a headache, but don’t underestimate what bad sitting posture can do, either.”

To learn more, please read “Can Sore Neck Muscles from Weight Lifting Cause Headache“.

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See What You Hit

Written by admin on September 24, 2012 – 9:41 am -

Football is one of the most dangerous and violent sports. Though it has been considered the classic “contact sport,” it is more accurate to say it is the ultimate “collision sport.” While concussions currently garner the media spotlight, injuries to the neck and spine are ignored– until disaster strikes. Recently, defensive backs at Catawba and Tulane Universities both suffered severe cervical spine injuries. Last season, at Rutgers University, Eric LeGrand was injured while making a tackle, and he remains paralyzed from the neck down.

The cervical spine is comprised of the first 7 spinal vertebrae. The nerves that exit the cervical spine are vital to both basic and sophisticated body functions including respiration and movement. Cervical spine injuries typically result from an axial load, which is a force that originates at the top of the head and continues longitudinally down the spine. “Spearing” is the term used for a tackle in which the player leads with the head, and the top of the head makes initial contact with the opponent. This type of tackle has been banned in the NFL to ensure the safety of NFL athletes as well as the young players that emulate them. Roger Goodell, commissioner of the NFL, has said that football needs a “culture change” in order to become a safer sport at all levels. Rules changes are welcome, but to decrease the prevalence of these injuries, It is perhaps more important that coaches, parents, and players be educated in proper tackling technique. The NFL has joined with USA Football, the governing body of youth football, to form the “Heads Up Football” initiative to teach proper tackling technique and increase awareness of head and neck injuries. According to Heads Up “The right way of tackling begins with ‘the breakdown’: feet set, hands sunken, the arc of the back straight and the knees bent. The head is up at all times.” A player must always be able to “see what you hit.” If you can’t, your technique is incorrect.

Given the inherent danger of participation in football, it is important to have a well-coordinated medical team present at every game. These medical professionals include the athletic trainers, first responders, team doctors and EMS. Fortunately, these teams were present on the sidelines at Catawba, Tulane, and Rutgers, their skilled, rapid, and coordinated efforts were essential in achieving the best outcomes.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting or or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.

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