Caleb Behrend, Department of Orthopaedics, University of Rochester Medical Center, Rochester, USA, and others reported in the Journal of Bone and Joint Surgery (American volume) that, as smoking cessation is strongly associated with an improvement in patient-reported pain, there is a need for smoking cessation programmes for patients with painful spinal disorders.
Behrend et al commented that smoking is recognised as a modifiable risk factor for chronic pain disorders and studies have shown that smokers report an increased magnitude of pain compared with non-smokers. They wrote: “The purpose of the present study was to determine if there is an association with improved reported pain from this cost-effective intervention in addition to the dramatic benefits of smoking cessation on long-term health.”
Using a prospectively maintained database of 5,333 patients with axial or radicular pain related to a spinal disorder managed at two academic centres, Behrend et al assessed patients’ smoking history, secondary gain factors, Oswestry Disability Index (ODI) score, and Visual Analogue Scale (VAS) scores at the time of the initial visit compared with these values at the latest follow-up point. The authors also grouped patients into never smokers (2,634), smokers who quit prior to study entry (1,532), smokers who quit during the time of the study (253), and current smokers (914). The authors reported that, at the time of entry of care, never smokers and prior smokers reported significantly less pain than current smokers and those who quit smoking during the course of the study (p<0.001). Furthermore, there was no difference in reported pain between current smokers and those who quit at the beginning of the study period.
At the latest follow-up visit, Behrend et al said: “In all VAS pain rating scales, current smokers had significantly higher mean pain (p<0.001) when compared with patients who have never smoked and those who had previously quit smoking. Compared with patients who had never smoked, patients who had quit smoking prior to the study period reported significantly higher rates of mean worst pain (p=0.028) and average weekly pain (p=0.049).” They added that compared with patients who were smokers, patients who quit smoking “reported significantly greater improvement in VAS pain ratings for worst pain (p=0.013), current pain (p<0.05), and average weekly pain (p=0.024)”.
Behrend et al also reviewed number of patients with a >30% decrease in VAS worst pain rating, which represented pain being “much improved” or having “some improvement”. They found that the percentage of patients who had such a decrease was 31.2% among never smokers, 29.1% among prior smokers, 32% among those who quit smoking during the study, and 16.6% among current smokers. They wrote: “To have one additional patient report >30% decrease in initial pain on the average weekly VAS pain rating scale, the number of smokers who needed to quit during treatment was 6.2.” However while there was a significantly greater improvement in the ODI score among never smokers compared with current smokers, there was no differences in this score between other groups.
Concluding, the authors wrote: “The present study supports the need for smoking cessation programmes for patients with axial or radicular pain of spinal aetiology, given a strong association between improved patient-reported pain and smoking cessation.”
Behrend told Spinal News International: “I think the key point to stress to patients is that smoking is not only associated with an increased mortality but there is growing evidence it may decrease their quality of life long before that. This study found that patients who smoked suffered more from their spinal problems and quitting smoking was associated with improved pain. If patients want to feel better and live longer, then smoking cessation is probably a good idea.”
Glenn Rechtine, Department of Orthopaedics, University of Rochester Medical Center, Rochester, USA, was the principal investigator of the trial.