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TOBACCO AND MUSCULOSKELETAL PAIN Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

TOBACCO AND MUSCULOSKELETAL PAIN Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System. Objectives of the Mini Lecture. Goal of Mini Lecture: Provide students with knowledge about the effects of tobacco on musculoskeletal pain. Learning Objectives: Students will be able to:

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TOBACCO AND MUSCULOSKELETAL PAIN Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

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  1. TOBACCO AND MUSCULOSKELETAL PAIN Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

  2. Objectives of the Mini Lecture Goal of Mini Lecture: Provide students with knowledge about the effects of tobacco on musculoskeletal pain. • Learning Objectives: • Students will be able to: • Understand the relationship between tobacco use and back pain and understand the mechanism by which this occurs. • Discuss the relationship between tobacco and osteoporosis. • Review the effects of smoking on bone mineral density and the risk of fractures. • Understand the benefits of cessation in relation to bone loss and risk of hip fracture.

  3. Contents Core Slides Optional Slides Other Musculoskeletal Conditions Bone Mineral Density Bone Density and Age Risk of Hip Fracture and Age • Tobacco and Back Pain • How Smoking Causes Back Pain (1–2) • Tobacco and Osteoporosis • Smoking and Bone Mineral Density • Smoking and Fractures • Benefits of Smoking Cessation

  4. CORE SLIDES Tobacco and Musculoskeletal Pain Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

  5. Tobacco and Back Pain www.topnews.in/health/files/back-pain.jpg 1. Goldberg et al. 2000; 2. Mattila et al. 2008; 3. Scott et al. 1999; 24:1090 4. Ernst 1993 • Any Tobacco Use: • Non-specific back pain in men and women1 • Both high and low-back pain2 • Smoking: • Exacerbates back pain3 • Greater impact on persons with damaged spines3 • Risk factor for pain3,4

  6. How Smoking Causes Back Pain (1) 1. Ernst 1993; 2. Palmer et al. 2003 • Smoker’s cough  Increases intra-discal pressure  Sciatica and herniated discs1 • Mechanism: Carboxy-haemoglobin formation  nicotine-inducedvasoconstriction  arterio-sclerotic vessel wall changes  impairmentof fibrinolytic activity and changes in the flow propertiesof blood  Malnutrition of disc  renders it more vulnerable to mechanical stress.2

  7. How Smoking Causes Back Pain (2) 1. Ernst 1993; 2. Palmer et al. 2003 • Frequent coughing and concurrent unhealthy life style (unhealthy diet, lack of exercise, use of alcohol) predispose to back pain1 • Affects neurological processing of sensory information ornutrition of peripheral tissues2 • People with a low pain and disability threshold: more likely to take up and continue smoking2

  8. Tobacco and Osteoporosis http://www.nlm.nih.gov/MEDLINEPLUS/ency/imagepages/17287.htm 1. Ill et al. 1993; 2. Quandt et al. 2005; 3. Tziomalos et al.; 4. Conrad (no date) • Smoking1 and smokeless tobacco use:2 risk factor for osteoporosis • Mechanisms of osteoporosis:3,4 • Early menopause • Decreased 25 hydroxyvitamin D • Decreased calcium absorption • Calcitonin resistance • Hormone Replacement: Ineffective in postmenopausal women smokers1

  9. Smoking and Bone Mineral Density http://www.pitt.edu/~kaf24/index.html 1. Ward and Klesges 2001 • Smokers  greater rates of bone loss over time1 • Significant bone mass differences between the two groups1

  10. Smoking and Fractures http://www.hughston.com/hha/a_11_4_1.htm 1.   Høidrup et al. 2000; 2. Law and Hackshaw 1997 • Tobacco smoking: Independent risk factor for hip fracture and increased lifetime fracture risk (women: 31% & men: 40%).1 • Also increased lifetime risk of developing vertebral fracture (women: 13% & men: 32%).2

  11. Benefits of Smoking Cessation • Smoking has a dose-dependent effect on bone loss  increases fracture risk (may be partially reversed by smoking cessation).1 • Smoking cessation  decreased risk of hip fractures in men after 5 years; however, effect is more long-lasting in female ex-smokers.1 1. Law and Hackshaw 1997

  12. OPTIONAL SLIDES Tobacco and Musculoskeletal Pain Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

  13. Other Musculoskeletal Conditions1 http://www.eorthopod.com/public/patient_education/6622/sacroiliac_joint_dysfunction.html 1. Conrad, http://www.orthosmoke.org/orthoSmoke.pdf • Smoking causes increased • risk of: • Osteo-necrosis femoral head • Non-union • Adverse effect on arthrodesis • Rheumatoid arthritis in twins • Dupuytren’s contracture • Reflex sympathetic dystrophy

  14. POSSIBLE MECHANISMS: HOW SMOKING LEADS TO LOW BMD ? Bone Mineral Density (BMD) http://medgenmed.medscape.com/viewarticle/408508_print

  15. Bone Density and Age Report of the Surgeon General's Workshop on Osteoporosis and Bone Health December 12-13, 2002, Washington, D.C http://www.surgeongeneral.gov/topics/bonehealth/workshop_report/workshop_rpt.htm

  16. Risk of Hip Fracture and Age Report of the Surgeon General's Workshop on Osteoporosis and Bone Health December 12-13, 2002, Washington, D.C http://www.surgeongeneral.gov/topics/bonehealth/workshop_report/workshop_rpt.htm

  17. The most important health message a doctor can give to patients is to quit smoking.

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