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Volume: 33  Issue: 3  Year: 2020
  Is Chronic Low Back Pain and Radicular Neuropathic Pain Associated with Smoking and a Higher Nicotine Dependence? A Cross-Sectional Study Using the DN4 and the Fagerström Test for Nicotine Dependence. [Ağrı]
Ağrı. 2021; 33(3): 155-167 | DOI: 10.14744/agri.2021.79836  

Is Chronic Low Back Pain and Radicular Neuropathic Pain Associated with Smoking and a Higher Nicotine Dependence? A Cross-Sectional Study Using the DN4 and the Fagerström Test for Nicotine Dependence.

Emanuel Schembri1, Victoria Massalha2, Liberato Camilleri3, Stephen Lungaro-Mifsud4
1Physiotherapy Outpatients, Karin Grech Hospital, Guardamangia Hill, Pieta PTA 1312, Malta; Master of Science (MSc) Candidate, MSc Clinical Management of Pain (Headache), University of Edinburgh, UK.
2Professional Lead, Physiotherapy services, Ministry for Health, Malta; Senior Lecturer, Physiotherapy Department, Faculty of Health Sciences, University of Malta, Msida, Malta
3Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
4Deputy Dean, Faculty of Health Sciences, University of Malta, Msida, Malta

Objective – To evaluate if a current smoking status and a higher nicotine dependence were associated with chronic low back pain and/or radicular neuropathic pain.

Materials and methods- A cross-sectional study was conducted on the first eligible consecutive 120 patients. Demographic data, pain intensity, worst pain location, most distal pain radiation, the DN4 questionnaire, STarT back tool, and the Fagerström Test were collected during the initial examination. An age- and gender-matched control group (n=50), free from chronic low back pain was recruited.

Results- In the chronic pain group, there was a significant difference between smokers and lifetime non-smokers in the average pain intensity (p=0.037), total DN4 score (p=0.002), STarT Back tool (p=0.006), worst pain location (p=0.023) and the most distal pain radiation (p=0.049). The mean total DN4 score increased with a corresponding increase in the number of cigarettes smoked daily (p=0.002). Current smokers had an OR of 3.071 (p=0.013) (95% CI 1.268-7.438) for developing chronic low back pain and lumbar related leg pain and an OR of 6.484 (p<0.001) (95% CI 2.323-18.099) for developing chronic radicular neuropathic leg pain. For every one-unit increase in the Fagerström test score, the likelihood for chronic low back pain and lumbar related leg pain increased by 40.71% (p=0.008) (95% CI 1.095-1.809) and for chronic radicular neuropathic leg pain increased by 71.3% (p<0.001) (95% CI 1.292-2.272).

Conclusion- A current smoking status and a higher nicotine dependence were both independently associated with an increased risk for chronic low back pain and/or chronic radicular neuropathic pain.

Keywords: Chronic Pain, Low Back Pain, Radiculopathy, Neuralgia, Sciatica, Smoking, Nicotine, Tobacco Use disorder, Cross-Sectional Studies.


Emanuel Schembri, Victoria Massalha, Liberato Camilleri, Stephen Lungaro-Mifsud. Is Chronic Low Back Pain and Radicular Neuropathic Pain Associated with Smoking and a Higher Nicotine Dependence? A Cross-Sectional Study Using the DN4 and the Fagerström Test for Nicotine Dependence.. Ağrı. 2021; 33(3): 155-167

Corresponding Author: Emanuel Schembri, Malta


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