Smoking May Affect Back Pain Treatments

The ill effects of smoking on health are not unknown to us. Newer research published online in the Annals of the Rheumatic Diseases is now throwing light on how smoking impairs the treatment process of inflammatory arthritis affecting the lower back, known as axial spondyloarthritis. Interestingly, quitting smoking may help reduce your lower back pain!

The chance of developing rheumatoid arthritis, a disease affecting millions all over the world, increases

with smoking. Several drugs won’t be as effective as they should be while treating rheumatoid arthritis in smokers. The drugs used to treat lower back problems are less effective because smoking reduces the effectiveness of drugs.

Axial spondyloarthritis is still under research and newly defined, so the impact of smoking on it is not very clear. In the Swiss Clinical Quality Management Cohort (SCQM), 700 patients with confirmed AxSpA were studied between 2005 and 2014. The researchers studied the effect of biological drugs known as tumor necrosis factor inhibitors in these patients and recorded their treatment response. In this study, about 62% participants were smokers and 38% were non-smokers.

BASDAI and ASDAS scores are commonly recognized criteria to quantify disease activity. These were used to judge the response from treatment after 1-2 years. Factors like age, sex, symptom duration, weight, and exercise affect the power of treatment on BASDAI scores. Patients who had quit smoking responded to the drug treatment well and achieved better BASDAI and ASDAS scores compared to current smokers. Present smoking status affected the response to treatment, but past smoking did not. More so, it adversely affected patients with higher level of an inflammatory marker (C reactive protein or CRP) in the beginning.

After one year of regular treatment, only 10% to 20% of current smokers, and 50% of past smokers fell in the baseline disease activity score (BASDAI) of non-smokers. Yet, it is unclear how exactly smoking hampers the response to treatment with tumor necrosis factor inhibitors. According to researchers, smoking causes the C reactive protein to increase pain by interfering with the neural processing of sensory transformation. Also, smoking tends to reduce oxygen transmission to key tissues. These are the probable reasons why smokers do not respond well to back pain treatment. Consider your smoking habits when seeking solutions for your back pain.

Contributed by Dr. Rachita Narsaria, MD

Reference:

Annals of the Rheumatic Diseases, ard.bmj.com/lookup/doi/10.1136… rheumdis-2013-205133