Back pain is a very common problem. It accounts for a lot of public suffering and cost, particularly in populations where labor jobs factor in heavily. Since we frequently see chronic smoking behavior in patients with disabling back pain, it is not surprising that research demonstrates a causal connection. While we wait for even more definitive studies, Chiropractors can support Public Health Initiatives to quit smoking in order to help their patients prevent back pain.
Back pain is a significant public health priority. Back and neck pain are two of the most common reasons people visit primary care physicians and chiropractors in the United States, and a cause considerable disability and financial burden. Further, back pain is the second leading cause of disability in the United States, and Low back pain (LBP) is a major public health problem worldwide. A 2014 perspective in Insights in Public Health shows that all age groups are affected, including children and adolescents, with 1%–2% of adults in the United States being disabled as a result. People with back pain paid health care costs that were 60% higher than for people who did not have back pain.
It is widely accepted that smoking is a problem, both with comorbid conditions like cancer, cardiovascular problems and respiratory diseases, but does it affect back pain? The answer is “Yes”, daily smoking has been shown to increase the risk of low back pain, especially amongst young adults. (Occasional smoking also slightly increased the odds of having chronic LBP.)
In 2012, a prospective review of 5,322 patients found that patients who had never smoked experienced significantly less pain than those who did, and that patients who quit smoking during pain management treatment experienced better outcomes than patients who continued to smoke.
Dr. Brian White is an interventional physiatrist with the Bassett Healthcare Network in Cooperstown, N.Y. At the annual meeting of the American Academy of Pain Management in 2015, he declared that smokers with lower back pain “must quit to alleviate symptoms”. Dr. White pointed out that structural damage caused by smoking can lead to increased risk of osteoporosis, lumbar disk disease, and impaired bone and wound healing, along with impaired oxygen to the tissues. Smoking also changes the way that pain is perceived, both in onset of pain (latency) and perceived severity.
Dr. Bart Green, a California DC, MSEd, DACBSP working in public health concerns, is a great inspiration for us. Dr Green suggests that smoking cessation can be a powerful public health prevention strategy for back pain. Most chiropractors are going to encourage patients to maintain an overall healthy lifestyle but specifically addressing smoking habits may have direct implications for each patient’s back pain experience. This is a form of is a form of secondary prevention.
This suggests that all chiropractic and medical back pain treatment programs could benefit from adding strategies to modify smoking habits.
At Blue Heron Chiropractic, we are committed to looking into root causes of dysfunction, disorder or disturbance. We believe that discussing smoking cessation and helping patients quit can decrease their pain and improve their overall health. A lot of our patients are already wanting to stop. Pointing out the connection between smoking and pain is often what is needed to make the move to quit. A more complete positive clinical outcome would be both decreasing the back pain and help the patient end their smoking habit. The plan will be to help identify proven strategies for cessation and support the patient in a forwarding way. We are on your team, and we have got your back.
As we have discussed in previous blogs, Blue Heron remains committed to helping patients avoid or eliminate opioid dependencies. We are conscious of work suggesting that smoking can make opioids less effective for pain management. Quoting Dr. White, above, “Smokers have higher pain scores and higher opioid use, but lower serum hydrocodone levels”. This would suggest that smoking increases the metabolism of the opioids, making them less effective and leading to increased utilization. Smoking is a modifiable behavior. If quitting smoking can decrease risk and prevalence of back pain, it should be taken seriously.
Blue Heron Chiropractic specializes in understanding and helping control both Old pain and New pain. We specialize in Vitality, Motor Vehicle Accident Recovery and Work Injuries. Smoking cessation can only add to all of this. Finally, if you have questions about how Dr. Dana Sibilla and Chiropractic can help you, or about exercise, optimal function, pain or pain management, schedule an appointment today.