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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of chronic musculoskeletal pain.Best Pract Res Clin Rheumatol. 2007; 21: 403-425
- Epidemiological features of chronic low-back pain.Lancet. 1999; 354: 581-585
- Impairment of health and quality of life in people with large waist circumference.Lancet. 1998; 351: 853-856
- Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys.BMJ. 2002; 325: 743
- A systematic review of low back pain cost of illness studies in the United States and internationally.Spine J. 2008; 8: 8-20
- Risk factors for the development of low back pain in adolescence.Am J Epidemiol. 2001; 154: 30-36
- US national prevalence and correlates of low back and neck pain among adults.Arthritis Rheum. 2007; 57: 656-665
- Smoking and low back pain.Spine (Phila Pa 1976). 1999; 24: 1463-1470
- A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes.Spine (Phila Pa 1976). 2000; 25: 995-1014
- Risk factors of atherosclerosis and shoulder pain—is there an association?.Eur J Pain. 2008; 12: 412-426
- Cardiovascular and lifestyle risk factors in lumbar radicular pain or clinically defined sciatica: a systematic review.Eur Spine J. 2007; 16: 2043-2054
- Cochrane Handbook for Systematic Reviews of Interventions 4.2.5.([updated May 2005]) John Wiley & Sons, Ltd, Chichester, UK2005 (Available at: http://www.cochrane.org/resources/handbook/hbook.htm)
- Low-back pain definitions in occupational studies were categorized for a meta-analysis using Delphi consensus methods.J Clin Epidemiol. 2007; 60: 625-633
- Approaches to heterogeneity in meta-analysis.Stat Med. 2001; 20: 3625-3633
- Uncertainty in heterogeneity estimates in meta-analyses.BMJ. 2007; 335: 914-916
- Meta-regression Approaches: What, Why, When, and How?.(Technical Review 8 (Prepared by Southern California–RAND Evidence-based Practice Center, Santa Monica, CA; 2004. AHRQ Publication No. 04-0033)) Agency for Healthcare Research and Quality, Rockville, MD2004
- Quantitative synthesis in systematic reviews.Ann Intern Med. 1997; 127: 820-826
- Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463
- Epidemiological study of low back pain and occupational risk factors among taxi drivers.Ind Health. 2008; 46: 112-117
- The association between social factors, employment status and self-reported back pain—a representative prevalence study on the German general population.J Public Health. 2005; 13: 30-39
- Musculoskeletal pain and smoking in Norway.J Epidemiol Community Health. 1996; 50: 166-169
- Low Back Pain among Industrial Workers.Department of Public Health, Karolinska Institute, Stockholm, Sweden2007
- Socioeconomic influences on back problems in the community in Britain.J Epidemiol Community Health. 1994; 48: 166-170
- Prevalence and risk factors for low back pain among professional cooks working in school lunch services.BMC Public Health. 2007; 7: 171
- Trends of back pain in eastern Finland, 1972-1992, in relation to socioeconomic status and behavioral risk factors.Am J Epidemiol. 1998; 148: 671-682
- Socioeconomic variation in back and joint pain in Finland.Eur J Epidemiol. 1998; 14: 79-87
- Does smoking cause low back pain?.J Manipulative Physiol Ther. 1996; 19: 99-108
- Why has the search for causes of low back pain largely been nonconclusive?.Spine (Phila Pa 1976). 1997; 22: 877-881
- Low back pain and lifestyle.Spine (Phila Pa 1976). 1998; 23 (discussion 2214): 2207-2213
- Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population.Spine (Phila Pa 1976). 2006; 31: E968-E972
- Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople.Occup Environ Med. 1996; 53: 351-356
- Influence of physical, psychological and behavioural factors on consultations for back pain.Br J Rheumatol. 1995; 34: 156-161
- Low-back pain in commercial travelers.Scand J Work Environ Health. 1992; 18: 52-58
- A questionnaire survey of Norwegian taxi drivers' musculoskeletal health, and work-related risk factors.Int J Ind Ergon. 2008; 38: 280-290
- Low back pain: prevalence and associated risk factors among hospital staff.J Adv Nurs. 2009; 65: 516-524
- Low back pain and its risk indicators: a survey of 7,040 Finnish male conscripts.Eur Spine J. 2008; 17: 64-69
- Chronic low back pain in a Southern Brazilian adult population: prevalence and associated factors [Portuguese].Cad Saude Publica. 2004; 20: 377-385
- Determinants of sciatica and low-back pain.Spine (Phila Pa 1976). 1991; 16: 608-614
- Level of education and back pain in France: the role of demographic, lifestyle and physical work factors.Int Arch Occup Environ Health. 2009; 82: 643-652
- Widespread musculoskeletal chronic pain associated with smoking.Scand J Rehabil Med. 1998; 30: 185-191
- Low back pain, lifestyle factors and physical activity: a population based-study.J Rehabil Med. 2008; 40: 864-869
- Long-term back problems and physical work exposures in the 1990 Ontario Health Survey.Am J Public Health. 1996; 86: 382-387
- Smoking, heavy physical work and low back pain: a four-year prospective study.Occup Med (Lond). 1999; 49: 155-160
- Predictors of low back pain onset in a prospective British study.Am J Public Health. 2001; 91: 1671-1678
- Cardiovascular risk factors and low-back pain in a long-term follow-up of industrial employees.Scand J Work Environ Health. 2006; 32: 12-19
- Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population.Arthritis Rheum. 2007; 56: 1355-1364
- Occupational loading, health behavior and sleep disturbance as predictors of low-back pain.Scand J Work Environ Health. 2008; 34: 411-419
- Are risk factors for atherothrombotic disease associated with back pain sickness absence?.J Epidemiol Community Health. 1999; 53: 197-203
- Prognostic factors related to recurrent low-back pain and sickness absence.Scand J Work Environ Health. 2004; 30: 459-467
- Risk factors for sick leave due to low back pain: a prospective study.J Occup Environ Med. 2002; 44: 451-458
- Headache, stomachache, backache, and morning fatigue among adolescent girls in the United States: associations with behavioral, sociodemographic, and environmental factors.Arch Pediatr Adolesc Med. 2004; 158: 797-803
- Are lifestyle-factors in adolescence predictors for adult low back pain?.BMC Musculoskelet Disord. 2006; 7: 27
- Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study.Eur Spine J. 1999; 8: 444-450
- Smoking.Spine (Phila Pa 1976). 1999; 24: 2492-2496
- Is smoking a risk factor for low back pain in adolescents?.Spine (Phila Pa 1976). 2008; 33: 527-532
- Childhood and early adult predictors of risk of incident back pain: Ontario Child Health Study 2001 follow-up.Am J Epidemiol. 2005; 162: 779-786
- The prevalence of locomotor complaints in middle age and their relationship to health and socioeconomic factors.Clin Orthop Relat Res. 1994; 308: 264-270
- Association between musculoskeletal pain in Japanese construction workers and job, age, alcohol consumption, and smoking.Ind Health. 1999; 37: 449-456
- Back disorders (low back pain, cervicobrachial and lumbosacral radicular syndromes) and some related risk factors.J Neurol Sci. 2001; 192: 17-25
- Is hormone replacement therapy a risk factor for low back pain among postmenopausal women?.Spine (Phila Pa 1976). 1998; 23: 809-813
- Low-back pain in relation to other diseases and cardiovascular risk factors.Spine (Phila Pa 1976). 1983; 8: 277-285
- Prevalence and risk factors associated with low back pain among health care providers in a Kuwait hospital.Spine (Phila Pa 1976). 2008; 33: 539-545
- Occupational and individual factors related to musculoskeletal symptoms in five body regions among Swedish nursing personnel.Int Arch Occup Environ Health. 1995; 68: 27-35
- Low back pain prevalence in Turkish pregnant women.J Back Musculoskeletal Rehabil. 2006; 19: 89-96
- An epidemiologic study of occupational low back pain in truck drivers.J Nippon Med Sch. 2000; 67: 186-190
- Back pain remains a common symptom in old age.Eur Spine J. 2003; 12: 528-534
- Back and neck pain exhibit many common features in old age: a population-based study of 4,486 Danish twins 70-102 years of age.Spine (Phila Pa 1976). 2004; 29: 576-580
- Low back pain among textile workers.Indian J Occup Environ Med. 2003; 7: 27-29
- Lifestyle and low-back pain.Spine (Phila Pa 1976). 1989; 14: 501-506
- Low back pain among Iranian industrial workers.Occup Med (Lond). 2006; 56: 455-460
- Low back pain among nurses: a follow-up beginning at entry to the nursing school.Spine (Phila Pa 1976). 2005; 30: 2334-2341
- Back pain and associated factors in French nurses.Int Arch Occup Environ Health. 1994; 66: 349-357
- Musculoskeletal symptoms of dentists assessed by a multidisciplinary approach.Community Dent Oral Epidemiol. 1991; 19: 38-44
- Analysis by sex of low back pain among workers from small companies in the Paris area: severity and occupational consequences.Occup Environ Med. 1999; 56: 696-701
- Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors.Spine (Phila Pa 1976). 1992; 17: 663-671
- “Cross-sectional” study of low back pain among workers at an industrial enterprise in Russia.Spine (Phila Pa 1976). 1995; 20: 328-332
- Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study.Spine (Phila Pa 1976). 2006; 31: 1149-1155
- Low back pain among rural and urban populations in Southwest Nigeria.Afr Newsl Occup Health Saf. 2002; 12: 57-59
- Risk factors for low back pain among office workers in Ibadan, Southwest Nigeria.Occup Med (Lond). 2003; 53: 287-289
- Back pain and peripheral joint pain in an industrial setting.Arch Phys Med Rehabil. 1996; 77: 385-390
- Predictors of back pain in a general population cohort.Spine (Phila Pa 1976). 2004; 29 (discussion 77-78): 70-77
- Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women—the MORGEN study.Spine (Phila Pa 1976). 2006; 31: 1496-1502
- Prevalence and factors associated to low back pain among hospital staff.Joint Bone Spine. 2005; 72: 254-259
- A prospective cohort study of risk factors for disability retirement because of back pain in the general working population.Spine (Phila Pa 1976). 2002; 27: 1790-1796
- The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men.Spine (Phila Pa 1976). 1995; 20: 699-709
- A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women.Ann Rheum Dis. 1991; 50: 158-161
- Incidence and risk factors of low-back pain in middle-aged farmers.Occup Med (Lond). 1995; 45: 141-146
- A prospective study of the role of cardiovascular risk factors and fitness in industrial back pain complaints.Spine (Phila Pa 1976). 1989; 14: 141-147
- Medical, social and occupational history as risk indicators for low-back trouble in a general population.Spine (Phila Pa 1976). 1986; 11: 720-725
- Oral contraception and other factors in relation to back disorders in women: findings in a large cohort study.Contraception. 1999; 60: 331-335
- Prevalence of functional pain of the back, the hip and the knee in adolescents.Dtsch Med Wochenschr. 2004; 129: 2285-2290
- Neck or shoulder pain and low back pain in Finnish adolescents.Scand J Public Health. 2000; 28: 164-173
- Risk factors of back pain frequency in schoolchildren: a search for explanations to a public health problem.Acta Paediatr. 2002; 91: 849-854
- Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study.Eur Spine J. 2005; 14: 331-336
- Severe back pain among farmworker high school students from Starr County, Texas: baseline results.Ann Epidemiol. 2007; 17: 132-141
- Epidemiological aspects and risk factors for low back pain in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.Eur Spine J. 1996; 5: 312-318
- Predictors of low back pain hospitalization—a prospective follow-up of 57,408 adolescents.Pain. 2008; 139: 209-217
- Dissecting complex disease: the quest for the Philosopher's Stone?.Int J Epidemiol. 2006; 35: 562-571
- Influence of smoking on the health status of spinal patients: the National Spine Network database.Spine (Phila Pa 1976). 2002; 27: 313-319
- Proposed identification of environmental tobacco smoke as a toxic air contaminant (June 24, 2005). Tobacco Control. Surveys and Program Evaluations from Outside UCSF. Paper CALEPA2005.
- Adjusting for publication bias in the presence of heterogeneity.Stat Med. 2003; 22: 2113-2126
- Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.Stat Med. 2007; 26: 4544-4562
- Effects of nicotine on the intervertebral disc: an experimental study in rabbits.J Orthop Sci. 2001; 6: 177-182
- Disc degeneration/back pain and calcification of the abdominal aorta.Spine (Phila Pa 1976). 1997; 22 (discussion 1648-1649): 1642-1647
- The association between carotid intima-media thickness and sciatica.Semin Arthritis Rheum. 2007; 37: 174-181
- Association of lumbar arterial stenosis with low back symptoms: a cross-sectional study using two-dimensional time-of-flight magnetic resonance angiography.Acta Radiol. 2009; 50: 48-54
- Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration.Spine (Phila Pa 1976). 2004; 29: 568-575
- A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect.BMJ. 1997; 315: 841-846
- The effects of smoking on bone health.Clin Sci (Lond). 2007; 113: 233-241
- The epidemiology of osteoporosis.J Rheumatol Suppl. 1996; 45: 2-5
- Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents.Nicotine Tob Res. 2008; 10: 525-532
- Systemic effects of smoking.Chest. 2007; 131: 1557-1566
- The pain of being sick: implications of immune-to-brain communication for understanding pain.Annu Rev Psychol. 2000; 51: 29-57
- Gene expression changes in an early stage of intervertebral disc degeneration induced by passive cigarette smoking.Spine (Phila Pa 1976). 2006; 31: 510-514
Article info
Footnotes
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.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
