Impact of Smoking on Opioid Use in Patients with Chronic Low Back Pain





0000-0003-0130-6629 (Chen, Easlie)

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Purpose: Low back pain is a leading cause of disability and healthcare costs. The costs to society are estimated to be up to $100 billion per year in the United States. Current cigarette smoking has been linked to physical impairment and severe chronic pain and studies have shown that daily smoking increases the risk of low back pain in a dose-dependent fashion. However, few studies have closely examined smoking cessation as a possible intervention for chronic low back pain and reduction of opioid use. Methods: This cross-sectional study utilized data from the PRECISION Pain Research Registry to examine the quantity of opioids used daily by patients with chronic low back pain according to smoking status (either current of former smokers). Reported daily opioid use was converted into morphine milligram equivalents (MMEs) using guidelines established by the Centers for Disease control and Prevention. Multiple linear regression was used to study the relationship between smoking status and opioid MMEs, including adjustment for age and gender as potential confounders. Results: There were 923 patients (264 male, 659 female). A total of 164 patients reported specific opioid drug use for MME conversion. Smoking status was not significantly associated with opioid MMEs (standardized beta coefficient= 0.062; P= 0.55). Neither age nor gender were associated with opioid MMEs. Conclusion: These findings show that smoking status may have little effect on the opioid MMEs used to treat chronic low back pain. However, smoking cessation may still provide substantial health benefits and reduce cancer risks.