Patients With Severe Back Pain Who Quit Smoking Report Less Pain Than Patients Who Continue To Smoke

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Main Category: Pain / Anesthetics
Also Included In: Smoking / Quit Smoking;  Back Pain
Article Date: 07 Dec 2012 - 1:00 PST Current ratings for:
Patients With Severe Back Pain Who Quit Smoking Report Less Pain Than Patients Who Continue To Smoke

For years, research has shown a link between smoking and an increased risk for low back pain, intervertebral (spine) disc disease, and inferior patient outcomes following surgery. A new study, published in the December 2012 Journal of Bone and Joint Surgery (JBJS), also found that smokers suffering from spinal disorders and related back pain, reported greater discomfort than spinal disorder patients who stopped smoking during an eight-month treatment period.

Nearly all adults will be seen at some time by a physician for back pain or other painful spinal disorders. As smoking has been identified as a modifiable risk factor for chronic pain disorders, researchers reviewed the smoking history and monitored the reported pain of more than 5,300 patients with axial (back) or radicular (leg) pain from a spinal disorder, treated surgically or non-surgically, over an eight-month period.

At the time of entry into care, patients who had never smoked and prior smokers reported significantly less back pain than current smokers and those who had quit smoking during the study period. Current smokers reported significantly greater pain in all visual analog scale (VAS) pain ratings - worst, current and average weekly pain - when compared with patients who had never smoked.

Other Key Findings:

Those who quit smoking during the course of care reported greater improvement in reported back pain than those who continued to smoke.
The mean improvement in VAS pain ratings was clinically significant in nonsmokers.
The group that continued smoking during treatment had no clinically significant improvement in reported pain.
Using the Oswestry Disability Index (the most commonly used outcome measure for low back pain assessment), greater mean improvement was observed in patients who had never smoked when compared to current smokers.
"We know that nicotine increases pain," said study author Glenn R. Rechtine, MD, University of Rochester Department of Orthopaedics. "In this study, if you quit smoking during treatment, you got better. If you continued to smoke, there was statistically no improvement, regardless of the treatment you had. Smoking is bad for you. Basically, the likelihood to improve your care - surgical or non-surgical - was dramatically decreased if you are a smoker.

"This study supports the need for smoking cessation programs for patients with a painful spinal disorder given a strong association between improved patient reported pain and smoking cessation," said Dr. Rechtine.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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American Academy of Orthopaedic Surgeons. "Patients With Severe Back Pain Who Quit Smoking Report Less Pain Than Patients Who Continue To Smoke." Medical News Today. MediLexicon, Intl., 7 Dec. 2012. Web.
14 Mar. 2013. APA

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'Patients With Severe Back Pain Who Quit Smoking Report Less Pain Than Patients Who Continue To Smoke'

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Stanford Researchers Report Progress In Quest To Create Objective Method Of Detecting Pain

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Also Included In: Medical Devices / Diagnostics;  Back Pain
Article Date: 24 Dec 2012 - 0:00 PST Current ratings for:
Stanford Researchers Report Progress In Quest To Create Objective Method Of Detecting Pain

A method of analyzing brain structure using advanced computer algorithms accurately predicted 76 percent of the time whether a patient had lower back pain in a new study by researchers from the Stanford University School of Medicine.

The study, which was published online Dec. 17 in Cerebral Cortex, reported that using these algorithms to read brain scans may be an early step toward providing an objective method for diagnosing chronic pain.

"People have been looking for an objective pain detector - a 'pain scanner' - for a long time," said Sean Mackey, MD, PhD, chief of the Division of Pain Medicine and professor of anesthesiology, pain and perioperative medicine, and of neurosciences and neurology. "We're still a long way from that, but this method may someday augment self-reporting as the primary way of determining whether a patient is in chronic pain."

The need for a better way to objectively measure pain instead of relying solely on self-reporting has long been acknowledged. But the highly subjective nature of pain has made this an elusive goal. Advances in neuroimaging techniques have initiated a debate over whether this may be possible. Such a tool would be particularly useful in treating very young or very old patients or others who have difficulty communicating, Mackey said.

In a study published last year in PLoS ONE, Mackey and colleagues used computer algorithms to analyze magnetic resonance imaging scans of the brain to accurately measure thermal pain in research subjects 81 percent of the time. But the question remained whether this could be a successful method for measuring chronic pain.

The goal of the new study was to accurately identify patients with lower back pain vs. healthy individuals on the basis of structural changes to the brain, and also to investigate possible pathological differences across the brain.

Researchers conducted MRI scans of 47 subjects who had lower back pain and 47 healthy subjects. Both groups were screened for medication use and mood disorders. The average age was 37.

The idea was to "train" a linear support vector machine - a computer algorithm invented in 1995 - on one set of individuals, and then use that computer model to accurately read the brain scans and classify pain in a completely new set of individuals.

The method successfully predicted the patients with lower back pain 76 percent of the time.

"Lower back pain is the most common chronic condition we deal with," Mackey said. "In many cases, we don't understand the cause. What we have learned is that the problem may not be in the back, but in the amplification coming from the back to the brain and nervous system. In this study, we did identify brain regions we think are playing a role in this phenomena."

An estimated 100 million Americans suffer from chronic pain, and chronic low back pain, in particular, is the most common cause for activity limitation in those younger than 45, according to the study. The prevalence of lower back pain among the U.S. population has also risen significantly, from 3.9 percent in 1992 to 10.2 percent in 2006.

"Previous studies have shown that there are functional changes in the brain of a chronic pain patient, and we show that structural changes may be used to differentiate between those with chronic lower back pain and those without," said former research assistant Hoameng Ung, the first author of the study who is now an MD/PhD student at the University of Pennsylvania School of Medicine. "This observation also suggests a role of the central nervous system in chronic pain, and that some types of chronic low back pain may reflect pathology not within the back, but instead within the brain."

Study results suggested that lower back pain is characterized by a pattern of structural changes in the gray matter, the nervous tissue of the brain, showing indication of disease.

"Our investigation ... suggests that the pathology of lower back pain involves changes in gray matter that are present throughout a distributed system of pain processing and pain-associated areas within the brain," the study stated.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject. This work was supported by a grant from the National Institutes of Health (DA026092, DA029262, DA023609), an International Association for the Study of Pain collaborative research grant and the Redlich Pain Research Endowment.

Other Stanford authors included former graduate student Justin Brown, PhD; postdoctoral scholar Kevin Johnson, PhD; and Jarred Younger, PhD, assistant professor of anesthesiology, pain and perioperative medicine.

Stanford University Medical Center

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posted by Sarah on 12 Jan 2013 at 5:55 am

This is interesting. I have had chronic pain for 25 years. In the last 3 I have made significant recovery. Part of it was due to 'retraining' my brain to reduce the over active pain messages locking my body up with paralysing spasms. This was achieved by learning the Alexander Technique - it reset my body. Therefore the indication of 'disease' must be viewed in that it can be reversible - is disease the right term?

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'Stanford Researchers Report Progress In Quest To Create Objective Method Of Detecting Pain'

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