Smoking Linked (Yet More Firmly) to Chronic Musculoskeletal Pain

Responses to a statewide health survey of Kentucky women support and amplify links between cigarette smoking and chronic musculoskeletal pain. Among more than 6,000 adult women in Kentucky who have volunteered to provide information about their health, there was a direct dose-response relationship between smoking habits and reported chronic pain affecting the neck, back, joints, or head or resulting from conditions including fibromyalgia and sciatica.

The data are noteworthy because Kentucky has the third-highest smoking rate among the US states; about 25% of Kentuckians are smokers. Remarkably, 40% of never-smokers in the study population reported chronic pain of some kind, but the prevalence among smokers was half-again as high, at 60%. The relationship between daily consumption and risk of pain was direct: Former smokers had only a 20% increased risk, while a daily smoker had more than doubled odds (104%) of chronic pain, compared to never-smokers.

Association does not equal causation, of course, as the authors point out in their report in The Journal of Pain. People in chronic pain may self-medicate with nicotine, or another factor such as chronic depression may contribute to both smoking and chronic pain. But "we do know that most women start smoking in their teens, whereas most of these chronic pain syndromes begin later in life," observed coauthor David Mannino, MD, who is professor of medicine at the University of Kentucky. The report cites numerous previous studies suggesting an association between smoking and chronic pain.

In that the risk of pain is dramatically reduced among ex-smokers, the Kentucky team suggests, smoking cessation may prove an effective therapeutic strategy for reduction of chronic musculoskeletal pain.