The American Journal of Medicine
Volume 123, Issue 1 , Pages 87.e7-87.e35, January 2010

The Association between Smoking and Low Back Pain: A Meta-analysis

  • Rahman Shiri, MD, PhD

      Affiliations

    • Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
    • Corresponding Author InformationRequests for reprints should be addressed to Rahman Shiri, MD, PhD, Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki FIN-00250, Finland
    • ,
  • Jaro Karppinen, MD, PhD

      Affiliations

    • Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
    • Department of Physical Medicine and Rehabilitation, University of Oulu, Oulu, Finland
    • ,
  • Päivi Leino-Arjas, MD, PhD

      Affiliations

    • Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
    • ,
  • Svetlana Solovieva, PhD

      Affiliations

    • Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
    • ,
  • Eira Viikari-Juntura, MD, PhD

      Affiliations

    • Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland

Abstract 

Objective

To assess the association between smoking and low back pain with meta-analysis.

Methods

We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses.

Results

In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32).

Conclusions

Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.

Keywords: Incidence, Prevalence, Publication bias, Tobacco

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 Funding: None.

 Conflict of Interest: The authors declare that they have no competing interests.

 Authorship: All authors had a role in writing the manuscript. All authors contributed to the design of the review, as well as interpretation of the findings and preparing the report. R. Shiri and S. Solovieva carried out the MEDLINE searches. R. Shiri carried out the EMBASE searches. All authors assessed the quality of the studies. R. Shiri carried out the meta-analyses and drafted the manuscript. All authors critically revised the manuscript and approved the final version for submission.

PII: S0002-9343(09)00713-X

doi:10.1016/j.amjmed.2009.05.028

The American Journal of Medicine
Volume 123, Issue 1 , Pages 87.e7-87.e35, January 2010

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