Korean J Pain.  2020 Oct;33(4):359-377. 10.3344/kjp.2020.33.4.359.

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain: is there an association?

• Schembri E
• Massalha V
• Spiteri K
• Camilleri L
• Lungaro-Mifsud S

• KMID: 2507142
• DOI: http://doi.org/10.3344/kjp.2020.33.4.359

Abstract

Background
This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain.
Methods
A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were completed. A control group (n = 50) was recruited.
Results
There was a significant difference between current smokers and nonsmokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P= 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP “definite/probable” neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P= 0.007), while the likelihood for an IASP neuropathic grade of “definite/probable” increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score.
Conclusions
A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.

Keyword

Chronic Pain; Cross-Sectional Studies; Low Back Pain; Neuralgia; Nicotine; Non-Smokers; Radiculopathy; Smoking; Tobacco Use Disorder.

Figure

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  Fig. 1 Flow diagram of the participants in the study. LBP: low back pain.

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  Fig. 2 Flow diagram of the chronic pain subjects’ International Association for the Study of Pain neuropathic pain (NP) grading. MRI: magnetic resonance imaging.

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  Fig. 3 The 95% confidence intervals for the mean Fagerström score by International Association for the Study of Pain (IASP) neuropathic pain grade category.

Reference

1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. 2018; Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 392:1789–858. DOI: 10.1016/S0140-6736(18)32279-7. PMID: 30496104. PMCID: PMC6227754.

2. Krismer M, van Tulder M. 2007; Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol. 21:77–91. DOI: 10.1016/j.berh.2006.08.004. PMID: 17350545. PMCID: PMC6097436.

3. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. 2017; Neuropathic pain. Nat Rev Dis Primers. 3:17002. DOI: 10.1038/nrdp.2017.2. PMID: 28205574.

4. Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice AS, et al. 2011; A new definition of neuropathic pain. Pain. 152:2204–5. DOI: 10.1016/j.pain.2011.06.017. PMID: 21764514.

5. Choi YK. 2019; Lumbar foraminal neuropathy: an update on non-surgical management. Korean J Pain. 32:147–59. DOI: 10.3344/kjp.2019.32.3.147. PMID: 31257823. PMCID: PMC6615450.

6. Euro U, Knekt P, Rissanen H, Aromaa A, Karppinen J, Heliövaara M. 2018; Risk factors for sciatica leading to hospitalization. Eur Spine J. 27:1501–8. DOI: 10.1007/s00586-017-5182-8. PMID: 28612193. PMCID: PMC6484005.

7. Schembri E. 2019; Are opioids effective in relieving neuropathic pain? SN Compr Clin Med. 1:30–46. DOI: 10.1007/s42399-018-0009-4.

8. Ferreira PH, Beckenkamp P, Maher CG, Hopper JL, Ferreira ML. 2013; Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. Eur J Pain. 17:957–71. DOI: 10.1002/j.1532-2149.2012.00277.x. PMID: 23335362.

9. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. 2018; Risk factors for low back pain and sciatica: an umbrella review. Spine J. 18:1715–21. DOI: 10.1016/j.spinee.2018.05.018. PMID: 29792997.

10. Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M. 2014; Risk factors for first time incidence sciatica: a systematic review. Physiother Res Int. 19:65–78. DOI: 10.1002/pri.1572. PMID: 24327326.

11. Frost P, Johnsen B, Fuglsang-Frederiksen A, Svendsen SW. 2013; Lifestyle risk factors for ulnar neuropathy and ulnar neuropathy-like symptoms. Muscle Nerve. 48:507–15. DOI: 10.1002/mus.23820. PMID: 23424094.

12. Pourmemari MH, Viikari-Juntura E, Shiri R. 2014; Smoking and carpal tunnel syndrome: a meta-analysis. Muscle Nerve. 49:345–50. DOI: 10.1002/mus.23922. PMID: 23761223. PMCID: PMC7494374.

13. Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA. 2015; The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis. J Gen Intern Med. 30:1193–203. DOI: 10.1007/s11606-015-3354-y. PMID: 25947882. PMCID: PMC4510210.

14. Suzuki T, Iwamoto T, Ochi K, Mito K, Nakamura T, Suzuki K, et al. 2016; Cigarette smoking is associated with cubital tunnel syndrome. Muscle Nerve. 54:1136–8. DOI: 10.1002/mus.25389. PMID: 27571367.

15. Khan JS, Hah JM, Mackey SC. 2019; Effects of smoking on patients with chronic pain: a propensity-weighted analysis on the Collaborative Health Outcomes Information Registry. Pain. 160:2374–9. DOI: 10.1097/j.pain.0000000000001631. PMID: 31149975. PMCID: PMC6768701.

16. Çelik SB, Can H, Sözmen MK, Şengezer T, Kaplan YC, Utlu G, et al. 2017; Evaluation of the neuropathic pain in the smokers. Agri. 29:122–6. DOI: 10.5505/agri.2017.68815. PMID: 29039152.

17. Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, et al. 2016; Neuropathic pain: an updated grading system for research and clinical practice. Pain. 157:1599–606. DOI: 10.1097/j.pain.0000000000000492. PMID: 27115670. PMCID: PMC4949003.

18. Markman JD, Kress BT, Frazer M, Hanson R, Kogan V, Huang JH. 2015; Screening for neuropathic characteristics in failed back surgery syndromes: challenges for guiding treatment. Pain Med. 16:520–30. DOI: 10.1111/pme.12612. PMID: 25530081.

19. Attal N, Perrot S, Fermanian J, Bouhassira D. 2011; The neuropathic components of chronic low back pain: a prospective multicenter study using the DN4 Questionnaire. J Pain. 12:1080–7. DOI: 10.1016/j.jpain.2011.05.006. PMID: 21783428.

20. Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. 2019; The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 160:28–37. DOI: 10.1097/j.pain.0000000000001390. PMID: 30586068. PMCID: PMC7318717.

21. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. 2014; Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 12:1500–24. DOI: 10.1016/j.ijsu.2014.07.014. PMID: 25046751. PMCID: PMC6858139.

22. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. 2005; Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 113:9–19. DOI: 10.1016/j.pain.2004.09.012. PMID: 15621359. PMCID: PMC7425408.

23. Hasvik E, Haugen AJ, Gjerstad J, Grøvle L. 2018; Assessing neuropathic pain in patients with low back-related leg pain: comparing the painDETECT Questionnaire with the 2016 NeuPSIG grading system. Eur J Pain. 22:1160–9. DOI: 10.1002/ejp.1204. PMID: 29436056.

24. Furman MB, Johnson SC. 2019; Induced lumbosacral radicular symptom referral patterns: a descriptive study. Spine J. 19:163–70. DOI: 10.1016/j.spinee.2018.05.029. PMID: 29800710.

25. Tampin B, Broe RE, Seow LL, George SG, Tan J, Menon R, et al. 2019; Field testing of the revised neuropathic pain grading system in a cohort of patients with neck and upper limb pain. Scand J Pain. 19:523–32. DOI: 10.1515/sjpain-2018-0348. PMID: 30901318.

26. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. 1991; The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 86:1119–27. DOI: 10.1111/j.1360-0443.1991.tb01879.x. PMID: 1932883.

27. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. 2008; A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 59:632–41. DOI: 10.1002/art.23563. PMID: 18438893. PMCID: PMC7276483.

28. Beneciuk JM, Robinson ME, George SZ. 2015; Subgrouping for patients with low back pain: a multidimensional approach incorporating cluster analysis and the STarT Back Screening Tool. J Pain. 16:19–30. DOI: 10.1016/j.jpain.2014.10.004. PMID: 25451622. PMCID: PMC4274220.

29. Toh I, Chong HC, Suet-Ching Liaw J, Pua YH. 2017; Evaluation of the STarT Back Screening Tool for prediction of low back pain intensity in an outpatient physical therapy Setting. J Orthop Sports Phys Ther. 47:261–7. DOI: 10.2519/jospt.2017.7284. PMID: 28257616.

30. Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M. 2015; Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study. BMC Musculoskelet Disord. 16:201. DOI: 10.1186/s12891-015-0669-0. PMID: 26286385. PMCID: PMC4541753.

31. Beneciuk JM, Bishop MD, Fritz JM, Robinson ME, Asal NR, Nisenzon AN, et al. 2013; The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther. 93:321–33. DOI: 10.2522/ptj.20120207. PMID: 23125279. PMCID: PMC3588106.

32. WHO Regional Office for Europe. 2019. Data and statistics [Internet]. WHO Regional Office for Europe;Copenhagen: Available at: http://www.euro.who.int/en/health-topics/disease-prevention/tobacco/data-and-statistics.

33. Orhurhu VJ, Pittelkow TP, Hooten WM. 2015; Prevalence of smoking in adults with chronic pain. Tob Induc Dis. 13:17. DOI: 10.1186/s12971-015-0042-y. PMID: 26185492.

34. Goesling J, Brummett CM, Hassett AL. 2012; Cigarette smoking and pain: depressive symptoms mediate smoking-related pain symptoms. Pain. 153:1749–54. DOI: 10.1016/j.pain.2012.05.014. PMID: 22703693.

35. Patterson AL, Gritzner S, Resnick MP, Dobscha SK, Turk DC, Morasco BJ. 2012; Smoking cigarettes as a coping strategy for chronic pain is associated with greater pain intensity and poorer pain-related function. J Pain. 13:285–92. DOI: 10.1016/j.jpain.2011.11.008. PMID: 22325299. PMCID: PMC3293999.

36. Michna E, Ross EL, Hynes WL, Nedeljkovic SS, Soumekh S, Janfaza D, et al. 2004; Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 28:250–8. DOI: 10.1016/j.jpainsymman.2004.04.007. PMID: 15336337.

37. Shemory ST, Pfefferle KJ, Gradisar IM. 2016; Modifiable risk factors in patients with low back pain. Orthopedics. 39:e413–6. DOI: 10.3928/01477447-20160404-02. PMID: 27064774.

38. Shaw WS, Means-Christensen AJ, Slater MA, Webster JS, Patterson TL, Grant I, et al. 2010; Psychiatric disorders and risk of transition to chronicity in men with first onset low back pain. Pain Med. 11:1391–400. DOI: 10.1111/j.1526-4637.2010.00934.x. PMID: 20735749.

39. Zvolensky MJ, McMillan K, Gonzalez A, Asmundson GJ. 2009; Chronic pain and cigarette smoking and nicotine dependence among a representative sample of adults. Nicotine Tob Res. 11:1407–14. DOI: 10.1093/ntr/ntp153. PMID: 19828432. PMCID: PMC2784489.

40. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Varonen H, Kalso E, et al. 2007; Cardiovascular and lifestyle risk factors in lumbar radicular pain or clinically defined sciatica: a systematic review. Eur Spine J. 16:2043–54. DOI: 10.1007/s00586-007-0362-6. PMID: 17525856. PMCID: PMC2140143.

41. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. 2010; The association between smoking and low back pain: a meta-analysis. Am J Med. 123:87.e7–35. DOI: 10.1016/j.amjmed.2009.05.028. PMID: 20102998.

42. Shiri R, Falah-Hassani K. 2016; The effect of smoking on the risk of sciatica: a meta-analysis. Am J Med. 129:64–73.e20. DOI: 10.1016/j.amjmed.2015.07.041. PMID: 26403480.

43. Green BN, Johnson CD, Haldeman S, Griffith E, Clay MB, Kane EJ, et al. 2018; A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLoS One. 13:e0197987. DOI: 10.1371/journal.pone.0197987. PMID: 29856783. PMCID: PMC5983449.

44. Manninen P, Riihimäk H, Heliövaara M. 1995; Incidence and risk factors of low-back pain in middle-aged farmers. Occup Med (Lond). 45:141–6. DOI: 10.1093/occmed/45.3.141. PMID: 7605976.

45. Rivinoja AE, Paananen MV, Taimela SP, Solovieva S, Okuloff A, Zitting P, et al. 2011; Sports, smoking, and overweight during adolescence as predictors of sciatica in adulthood: a 28-year follow-up study of a birth cohort. Am J Epidemiol. 173:890–7. DOI: 10.1093/aje/kwq459. PMID: 21393341.