AJM onlineClinical research studyThe Association between Smoking and Low Back Pain: A Meta-analysis
Section snippets
Search Strategy
Studies of interest were identified by searches of the MEDLINE and EMBASE databases from 1966 until February 2009 using predefined keywords. In addition to smoking, our search covered a larger set of cardiovascular or lifestyle risk factors.10, 11 Our search was limited to human populations. All languages were accepted. We excluded reviews, case reports, letters, editorials, and guidelines. We also searched reference lists of included studies.
Selection of Studies
Two authors examined independently all titles and
Results
We identified 250 relevant study reports on the associations between cardiovascular risk factors and low back pain for detailed assessment (Figure 1). We included 81 studies on the relation between smoking and low back pain for systematic review (Appendix 2, Appendix 3). Finally, 40 (27 cross-sectional and 13 cohort) studies qualified for meta-analysis.
Discussion
This meta-analysis showed an association between smoking and low back pain. The association was strongest for chronic low back pain and disabling low back pain. Former smokers were at a lower prevalence of low back pain than current smokers. The association between smoking and the incidence of low back pain was stronger in adolescents than in adults.
The observed association between smoking and low back pain was modest. The multifactorial etiology of low back pain needs to be considered in the
Conclusions
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 is strongest for chronic or disabling low back pain. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults. Research is needed to investigate whether smoking prevention or cessation is associated with reduced incidence or severity of low back pain.
Acknowledgments
We thank Helena Liira for her assistance in selecting relevant studies. We thank Johan Hviid Andersen, Christina Björck-van Dijken, Lise Hestbæk, and Helena Miranda for sending us additional results.
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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.