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Smoking is Associated with Pain in all Body Regions, with Greatest Influence on Axial Pain. AAPM&R Annual Assembly, November 13-16 2014. Byron Schneider, MD 1 , Matthew Smuck, MD 1 , Elizabeth Martin, MD 1 , Ming- Chih J. Kao, PhD, MD 1,2

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smoking is associated with pain in all body regions with greatest influence on axial pain

Smoking is Associated with Pain in all Body Regions, with Greatest Influence on Axial Pain

AAPM&R Annual Assembly, November 13-16 2014

Byron Schneider, MD1, Matthew Smuck, MD1, Elizabeth Martin, MD1, Ming-Chih J. Kao, PhD, MD1,2

1 – PM&R Section, Department of Orthopaedic Surgery, Stanford University, CA, USA

2 – Pain Medicine Division, Department of Anesthesiology, Stanford University, CA, USA

disclosure
Disclosure

No relevant financial disclosures

background
Background
  • Meta analysis of international cross sectional studies has found that current smoking is associated with increased prevalence of current low back, chronic low back pain, and seeking medical treatment for low back pain
  • Its association with other regional body pain is not as well described
objective
Objective
  • Determine the relative associations between smoking and pain in multiple different body regions
  • Evaluate the mitigating effects of physical activity as a potential protective factor in the observed associations
methods
Methods

6,781 Subjects

2003-2004

NHANES Survey

Representative of US population

methods1
Methods
  • Data
  • - comprehensive pain report
  • - smoking history
  • - 7-day physical activity monitoring
  • - demographics
  • - anthropometrics
  • - medical history
  • Statistics
  • - custom SAS macros and Python 2.7
  • - weighted multivariate logistic regression analyses
results
Results
  • Significant associations between smoking and pain in all body regions except chest and foot pain
  • Clustered
  • - Axial (neck, upper and low back)
  • - Appendage (shoulder, arm, hand, leg, foot)
  • - Torso (chest, abdomen)
  • - Head (headache)
associations odds ratio between smoking and regional pain
Associations (Odds Ratio) between smoking and regional pain
  • All Regions Clusters

Head (2.47)

(2.47) Head

(2.35) Neck

Shoulder (2.37)

(2.77) Upper back

Axial (2.89)

Chest (0)

Abdomen (3.15)

(2.17) Torso

Arm (2.07)

(2.66) Lower back

Hand (2.23)

(1.99) Appendage

Leg (1.60)

Foot (0)

mitigating effects of physical activity
Mitigating effects of physical activity
  • Sustained light act. = 7-day average light activity bout
  • Axial
  • Appendage
  • Torso
  • Head
conclusions
Conclusions
  • This population-based study found significant associations between smoking and pain in nearly all regions and in all body clusters.
  • Smoking was most associated with axial pain, with a nearly 3x increase in risk
  • Physical activity does not mitigate the association between smoking and back pain or headache pain
  • Physical activity does mitigate some of the risk from smoking for trunk and appendage pain, where smoking has an overall less pronounced association with pain
thank you
THANK YOU

Byron Schneider, MD

PGY-IV Resident

Physical Medicine & Rehabilitation

Stanford University

bjschn2@stanford.edu