Elsevier

The American Journal of Medicine

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

AJM online
Clinical research study
The Association between Smoking and Low Back Pain: A Meta-analysis

https://doi.org/10.1016/j.amjmed.2009.05.028Get rights and content

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.

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.

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