smoking is associated with pain in all body regions, with greatest influence on axial pain
DESCRIPTION
Smoking is Associated with Pain in all Body Regions, with Greatest Influence on Axial Pain. AAPM&R Annual Assembly, November 13-16 2014. Byron Schneider, MD 1 , Matthew Smuck, MD 1 , Elizabeth Martin, MD 1 , Ming- Chih J. Kao, PhD, MD 1,2 - PowerPoint PPT PresentationTRANSCRIPT
Smoking is Associated with Pain in all Body Regions, with Greatest Influence on Axial Pain
AAPM&R ANNUAL ASSEMBLY, NOVEMBER 13-16 2014
Byron Schneider, MD1, Matthew Smuck, MD1, Elizabeth Martin, MD1, Ming-Chih J. Kao, PhD, MD1,2
1 – PM&R Section, Department of Orthopaedic Surgery, Stanford University, CA, USA2 – Pain Medicine Division, Department of Anesthesiology, Stanford University, CA, USA
Background
META ANALYSIS OF INTERNATIONAL CROSS SECTIONAL STUDIES HAS FOUND THAT CURRENT SMOKING IS ASSOCIATED WITH INCREASED PREVALENCE OF CURRENT LOW BACK, CHRONIC LOW BACK PAIN, AND SEEKING MEDICAL TREATMENT FOR LOW BACK PAIN
ITS ASSOCIATION WITH OTHER REGIONAL BODY PAIN IS NOT AS WELL DESCRIBED
Objective
DETERMINE THE RELATIVE ASSOCIATIONS BETWEEN SMOKING AND PAIN IN MULTIPLE DIFFERENT BODY REGIONS
EVALUATE THE MITIGATING EFFECTS OF PHYSICAL ACTIVITY AS A POTENTIAL PROTECTIVE FACTOR IN THE OBSERVED ASSOCIATIONS
Methods Stage 1: Primary sampling units (PSUs, ~counties), are selected
with probability proportional to a measure
of size (PPS)
Stage 2: PSUs are
divided up into segments
(~city blocks) with PPS
Stage 3: A sample of households is randomly
drawn from each segment. Oversampling for age,
ethnic, or income groups are done at this stage
Stage 4: Individuals are draw from each household, within
age/sex/race/ethnicity screening sub-domains (~1.6
persons per household)
6,781 Subjects
2003-2004NHANES Survey
Representative of US population
Methods
DATA- COMPREHENSIVE PAIN REPORT- SMOKING HISTORY- 7-DAY PHYSICAL ACTIVITY MONITORING- DEMOGRAPHICS- ANTHROPOMETRICS- MEDICAL HISTORY
STATISTICS- CUSTOM SAS MACROS AND PYTHON 2.7 - WEIGHTED MULTIVARIATE LOGISTIC REGRESSION ANALYSES
Results
SIGNIFICANT ASSOCIATIONS BETWEEN SMOKING AND PAIN IN ALL BODY REGIONS EXCEPT CHEST AND FOOT PAIN
CLUSTERED- AXIAL (NECK, UPPER AND LOW BACK) - APPENDAGE (SHOULDER, ARM, HAND, LEG, FOOT)- TORSO (CHEST, ABDOMEN)- HEAD (HEADACHE)
Associations (Odds Ratio) between smoking and regional pain
ALL REGIONS CLUSTERS
Head (2.47)
(2.35) Neck
Shoulder (2.37)
Arm (2.07)
Hand (2.23)
(2.77) Upper back
(2.66) Lower back
Abdomen (3.15)
Leg (1.60)
Chest (0)
Foot (0)
(2.47) Head
(2.17) Torso
Axial (2.89)
(1.99) Appendage
Associations between smoking and regional pain
Cluster Odds Ratio (95% CI) Axial 2.89 (2.21-3.37) Appendage 1.99 (1.45-2.73) Torso 2.17 (1.45-2.74) Head 2.47 (1.73-3.53)
Mitigating effects of physical activity
SUSTAINED LIGHT ACT. = 7-DAY AVERAGE LIGHT ACTIVITY BOUT
AXIAL APPENDAGE TORSO HEAD
Conclusions
THIS POPULATION-BASED STUDY FOUND SIGNIFICANT ASSOCIATIONS BETWEEN SMOKING AND PAIN IN NEARLY ALL REGIONS AND IN ALL BODY CLUSTERS.
SMOKING WAS MOST ASSOCIATED WITH AXIAL PAIN, WITH A NEARLY 3X INCREASE IN RISK
PHYSICAL ACTIVITY DOES NOT MITIGATE THE ASSOCIATION BETWEEN SMOKING AND BACK PAIN OR HEADACHE PAIN
PHYSICAL ACTIVITY DOES MITIGATE SOME OF THE RISK FROM SMOKING FOR TRUNK AND APPENDAGE PAIN, WHERE SMOKING HAS AN OVERALL LESS PRONOUNCED ASSOCIATION WITH PAIN
THANK YOU BYRON SCHNEIDER, MD
PGY-IV RESIDENTPHYSICAL MEDICINE & REHABILITATION
STANFORD [email protected]