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The Association Between Self-Reported Cigarette Smoking and Spinal Pain is Not Explained by Serum Cotinine Levels
Clermont E Dionne1, Danielle Laurin2, Thérèse Desrosiers3
1Centre de recherche du CHU de Québec-Université Laval, Quebec City (QC), Canada; Centre of Excellence on Aging (CEVQ), Quebec City (QC), Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City (QC), Canada; VITAM - Centre de recherche en santé durable, Quebec City (QC), Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City (QC), Canada.
Purpose:
The aim of this study was to check if self-reported smoking is still associated with back pain above and beyond its association with cotinine, to test the hypothesis that the association of self-reported cigarette smoking with back pain is due to residual confounding.
Methods:
Secondary analyses of population-based cross-sectional data pertaining to 4470 adults were conducted. In multivariate analyses examining the associations of self-reported smoking with several spinal pain outcomes (neck pain, low back pain, low back pain with pain below knee, self-reported diagnosis of arthritis/rheumatism, and related limitations), further adjustment for serum cotinine concentrations was made.
Results:
Self-reported cigarette smoking was associated with neck pain (adjusted Odds Ratio (aOR) Regular smokers vs. Non-smokers: 1.44; 95% Confidence Interval (CI): 1.14-1.82), low back pain (aOR: 1.48; 95% CI: 1.24-1.78), low back pain with pain below knee (aOR: 1.98; 95% CI: 1.42-2.76), as well as arthritis/rheumatism (aOR: 1.33; 95% CI: 1.03-1.71), and related functional limitations (P < .05). Further adjustment for serum cotinine concentrations brought about little change in the ORs or beta coefficients.
Conclusions:
These results do not support the hypothesis that serum cotinine concentrations explain the well-known relationship between cigarette smoking and spinal pain.
