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
(http://www.medscape.com/viewarticle/775989)

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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Graston Technique®: Decrease Pain and Improve Function

Written by admin on December 3, 2012 – 11:24 am -

Graston Technique® is an advanced form of soft tissue mobilization that utilizes stainless steel instruments to both detect and release scar tissue, adhesions, and fascial restrictions that occur in the body due to trauma or overuse. Originally developed in the 1990s, the Graston Technique® has become a tool for a wide variety of clinical and institutional settings including college and professional athletics.

During the healing process, our body attempts to repair damaged areas by creating scar tissue. Over time, this fibrous scar tissue builds up and can ultimately lead to pain and dysfunction because this replacement tissue is not as strong or flexible as healthy tissues. The Graston Technique® is designed to detect the build up of scar tissue, or adhesions. The instruments allow both the clinician and patient to find the areas of restriction and essentially “break up” those restrictive tissues. Most patients will receive a positive outcome within two to three treatments.

The Graston Technique® has been effective in a wide variety of conditions including but not limited to carpal tunnel syndrome, medial and lateral epicondylitis, IT band syndrome, back pain, muscle strains, and de Quervain’s syndrome. Most patients will feel better within two to three treatment sessions. A typical treatment session will consist of the following:

1. Warm-up

2. Graston Technique® Instrument-assisted Soft Tissue Mobilization

3. Stretching exercises

4. Strengthening exercises

5. Cryotherapy (cold pack)

The Graston Technique® is a manipulative treatment that utilizes significant force and pressure applied to the soft tissues, and as a result, possible side effects are likely to occur. Bruising is fairly common as the treatments will increase blood flow to the area. Soreness is common and develops within 24-72 hours after the treatment. The stretching exercises prescribed by the clinician will help decrease this soreness in the days after treatment. It is very important for the patient to maintain an adequate water intake. Appropriate hydration is essential in order to promote proper healing.

It is important to note that the Graston Technique® is just one part of the rehabilitation and treatment process. Successful outcomes will not be achieved with the instruments alone. Patient compliance with the necessary strengthening and stretching exercises is essential for positive outcomes.

Matt Rongstad is an Certified Athletic Trainer, Licensed in the state of NC. Matt is currently training in the GOSM Fellowship.

Dr. Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine practicing in Raleigh, NC. He serves as the team physician and orthopaedic consultant to the Carolina Mudcats, Cleveland Indians Single-A affiliate as well as many other local high schools and colleges. twitter@drmarkgalland.com.


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