PURPOSE:
Chronic low back pain (LBP) is one of the main causes of disability in the community. Although there have been studies suggesting an association between smoking and LBP, these studies were limited by the small numbers of patients, and they did not control for confounders. The objective of this study was to determine whether cigarette smoking is associated with an increased risk of chronic LBP among adults.

METHODS:
Using Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians aged 20 to 59 yr were identified. Self-reported chronic LBP status, smoking habits, sex, age, height, weight, level of activity and level of education were identified as well. Back pain secondary to fibromyalgia was excluded. Multivariate logistic regression analysis was used to detect effect modification and to adjust for covariates. Design effects associated with complex survey design were taken into consideration.

RESULTS:
The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers. Age and sex were found to be effect modifiers (P < 0.0001), and the relationship between smoking and chronic LBP risk was dependent on sex and age. The association between daily smoking and the risk of chronic LBP was stronger among younger individuals. Occasional smoking slightly increased the odds of having chronic LBP.

CONCLUSION:
Daily smoking increases the risk of LBP among young adults, and this effect seems to be dose-dependent. Back pain treatment programs may benefit from integrating smoking habit modification. Further research is required to develop effective prevention strategies.





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