News Release

Patients with severe back pain who quit smoking report less pain than patients who continue to smoke

Peer-Reviewed Publication

American Academy of Orthopaedic Surgeons

Rosemont, Ill. – 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.


About JBJS

December 5th Full JBJS Table of Contents

Denosumab Treatment in Postmenopausal Women with Osteoporosis Does not Interfere with Fracture Healing: Results from the FREEDOM Trial

Steroid Modulation of Cytokine Release and Desmosine Levels in Bilateral Total Knee Replacement: A Prospective Double-Bind, Randomized Controlled Trial

Qualitative and Quantitative Differences between Bone Graft Obtained from the Reamer Irrigator/Aspirator and the Iliac Crest of the Same Patient

Surgical vs. Nonsurgical Treatment of Acute Achilles Tendon Rupture: a Meta-Analysis of Randomized Trials

Results of Cemented Total Shoulder Replacement with Minimum Follow-up of 10 Years

Combined Glenoid Anteversion Osteotomy and Tendon Transfers for Brachial Plexus Birth Palsy: Early Outcomes

Cementless Total Hip Arthroplasty in Patients Age 50 and Under at Minimum 10-year Follow-up

Platelet-Rich Plasma Increases Matrix Metalloproteinases in Cultures of Human Synovial Fibroblastsreview

Smoking Cessation Related to Improved Patient Reported Pain Scores Following Spinal Care

Comparison of Glenoid Component Position Using Patient Specific Instruments vs. Standard Surgical Instruments: A Randomized Prospective Clinical Trial.

Femoral Component Revision with Use of Impaction Bone-grafting and a Cemented Polished Stem; A Concise Follow-up at 15-to-20 Years, of a Previous Report

The Influence of Insurance Status on Access and Utilization of a Tertiary Hand Surgery Referral Center

Erect Radiographs to assess clinical instability in patients with blunt cervical spine trauma

Prognostic Factors and Limits of Unconstrained Shoulder Arthroplasty for the Treatment of Post-traumatic Cephalic Collapse and Necrosis (Type 1 – Proximal Humerus Fracture Sequelae)

A Nation in Motion

More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide the best value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this "Nation in Motion." To learn more, to read hundreds of patient stories or to submit your own story, visit

More information on knee replacement can be found at

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.