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, USA2 – Pain Medicine Division, Department of Anesthesiology, Stanford University, CA, USA

Disclosure

NO RELEVANT FINANCIAL DISCLOSURES

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

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 Stage 1: Primary sampling units (PSUs, ~counties), are selected

with probability proportional to a measure

of size (PPS)

Stage 2: PSUs are

divided up into segments

(~city blocks) with PPS

Stage 3: A sample of households is randomly

drawn from each segment. Oversampling for age,

ethnic, or income groups are done at this stage

Stage 4: Individuals are draw from each household, within

age/sex/race/ethnicity screening sub-domains (~1.6

persons per household)

6,781 Subjects

2003-2004NHANES Survey

Representative of US population

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

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

ALL REGIONS CLUSTERS

Head (2.47)

(2.35) Neck

Shoulder (2.37)

Arm (2.07)

Hand (2.23)

(2.77) Upper back

(2.66) Lower back

Abdomen (3.15)

Leg (1.60)

Chest (0)

Foot (0)

(2.47) Head

(2.17) Torso

Axial (2.89)

(1.99) Appendage

Associations between smoking and regional pain

Cluster Odds Ratio (95% CI) Axial 2.89 (2.21-3.37) Appendage 1.99 (1.45-2.73) Torso 2.17 (1.45-2.74) Head 2.47 (1.73-3.53)

Mitigating effects of physical activity

SUSTAINED LIGHT ACT. = 7-DAY AVERAGE LIGHT ACTIVITY BOUT

AXIAL APPENDAGE TORSO HEAD

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 BYRON SCHNEIDER, MD

PGY-IV RESIDENTPHYSICAL MEDICINE & REHABILITATION

STANFORD UNIVERSITYBJSCHN2@STANFORD.EDU