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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, 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

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  1. 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

  2. Disclosure No relevant financial disclosures

  3. 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

  4. 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

  5. Methods 6,781 Subjects 2003-2004 NHANES Survey Representative of US population

  6. 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

  7. 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)

  8. 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)

  9. Associations between smoking and regional pain

  10. Mitigating effects of physical activity • Sustained light act. = 7-day average light activity bout • Axial • Appendage • Torso • Head

  11. 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

  12. THANK YOU Byron Schneider, MD PGY-IV Resident Physical Medicine & Rehabilitation Stanford University bjschn2@stanford.edu

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