Association of Smoking and Chronic Pain Syndromes in Kentucky Women


      The objective of this project was to determine the relationship between cigarette smoking and the reporting of chronic pain syndromes among participants in the Kentucky Women’s Health Registry. Data was analyzed on 6,092 women over 18 years of age who responded to survey questions on pain and smoking. The chronic pain syndromes included in the analysis were fibromyalgia, sciatica, chronic neck pain, chronic back pain, joint pain, chronic head pain, nerve problems, and pain all over the body. Analyses controlled for age, body mass index, and Appalachian versus non-Appalachian county of residence. Results showed that women who were daily smokers reported more chronic pain (defined as the presence of any reported chronic pain syndromes) than women who were never smokers (adjusted odds ratio [aOR] = 2.04 and 95% confidence interval [CI] 1.67, 2.49). An increased risk was also seen for “some-day” smokers (aOR 1.68, 95% CI 1.24, 2.27), and former smokers (aOR 1.20, 95% CI 1.06, 1.37), though with less of an association in the latter group. This study provides evidence of an association between chronic pain and cigarette smoking that is reduced in former smokers.


      This paper presents the association between smoking and musculoskeletal pain syndromes among Kentucky women. This finding may provide additional opportunities for intervention in patients with chronic pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alkherayf F.
        • Agbi C.
        Cigarette smoking and chronic low back pain in the adult population.
        Clin Invest Med. 2009; 32: E360-E367
        • Andersson H.I.
        • Ejlertsson G.
        • Leden I.
        Widespread musculoskeletal chronic pain associated with smoking: An epidemiological study in a general rural population.
        Scand J Rehabil Med. 1998; 30: 185-191
        • Averina M.
        • Nilssen O.
        • Brenn T.
        • Brox J.
        • Arkhipovsky V.L.
        • Kalinin A.G.
        Social and lifestyle determinants of depression, anxiety, sleeping disorders and self-evaluated quality of life in Russia: A population-based study in Arkhangelsk.
        Soc Psychiatry Psychiatr Epidemiol. 2005; 40: 511-518
        • Bailey B.A.
        • Jones Cole L.K.
        Rurality and birth outcomes: Findings from southern Appalachia and the potential role of pregnancy smoking.
        J Rural Health. 2009; 25: 141-149
        • Boshuizen H.
        • Verbeek J.
        Do smokers get more back pain?.
        Spine. 1993; 18: 35-40
      1. Centers for Disease Control and Prevention: About BMI for Adults. Available at: Accessed January 15, 2011

      2. Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System Survey (BRFSS). Available at: Accessed January 15, 2011

        • Centers for Disease Control and Prevention
        Coronary heart disease mortality trends among whites and blacks—Appalachia and United States, 1980–1993.
        Morbidity and Mortality Weekly Report. 1998; 47: 1005-1016
        • Centers for Disease Control and Prevention
        Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004.
        Morbidity and Mortality Weekly Report. 2008; 57: 1226-1228
        • Centers for Disease Control and Prevention
        State-specific smoking-attributable mortality and years of potential life lost—United States, 2000–2004.
        Morbidity and Mortality Weekly Report. 2009; 58: 29-33
        • Deyo R.
        • Bass J.
        Lifestyle and low back pain: The influence of smoking and obesity.
        Spine. 1989; 14: 501-506
        • Doleys D.M.
        Smoking and narcotics use among chronic pain patients.
        Psychol Rep. 1989; 64: 1253-1254
      3. Doyle S: People with neuropathic pain twice as likely to smoke cigarettes. Medscape Medical News. Available at: Accessed Jan 10, 2011

        • Finkelstein M.
        Back pain and parenthood.
        Occup Environ Med. 1995; 52: 51-53
        • Fishbain D.A.
        • Lewis J.E.
        • Cutler R.
        • Cole B.
        • Rosmoff R.S.
        • Rosmoff H.L.
        Does smoking status affect multidisciplinary pain facility treatment outcome?.
        Pain Med. 2008; 9: 1081-1090
        • Frymoyer J.
        • Pope M.
        Epidemiologic studies of low-back pain.
        Spine. 1980; 5: 419-423
        • Frymoyer J.
        • Pope M.
        • Clements J.
        Risk factors in low back pain.
        J Bone Joint Surg. 1983; 65A: 213
        • Hagen K.
        • Zwart J.A.
        • Svebak S.
        • Bovim G.
        • Stovner L.J.
        Low socioeconomic status is associated with chronic musculoskeletal complaints among 46,901 adults in Norway.
        Scand J Public Health. 2005; 33: 268-275
        • Heliovaara M.
        • Makela M.
        Determinants of sciatica and low back pain.
        Spine. 1991; 16: 608-614
        • Kelsey J.
        • Golden A.
        • Mundt D.
        Low back pain/prolapsed lumbar intervertebral disc.
        Epidemiol Rheum Dis. 1990; 16: 699-716
        • Khang Y.H.
        • Kim H.R.
        Gender differences in self-rated health and mortality association: Role of pain-inducing musculoskeletal disorders.
        J Women’s Health. 2009; 19: 109-116
        • Langballe E.M.
        • Innstrand S.T.
        • Hagtvet K.A.
        • Falkum E.
        • Aasland O.G.
        The relationship between burnout and musculoskeletal pain in seven Norwegian occupational groups.
        Work. 2009; 32: 179-188
        • Leboeuf-Yde C.
        Alcohol and low back pain: A systematic literature review.
        J Manipulative Physiol Ther. 2000; 23: 343-346
        • Manchikanti L.
        • Singh V.
        • Fellows B.
        • Pampati V.
        Evaluation of influence of gender, occupational injury, and smoking on chronic low back pain of facet joint origin: A subgroup analysis.
        Pain Physician. 2002; 5: 30-35
        • Morse T.
        • Bruneau H.
        • Michalak-Turcotte C.
        • Sanders M.
        • Warren N.
        • Dussetschleger J.
        • Diva U.
        • Croteau M.
        • Cherniack M.
        Musculoskeletal disorders of the neck and shoulder in dental hygienists and dental hygiene students.
        J Dent Hyg. 2007; 81: 1-16
        • Nakata A.
        • Takahashi M.
        • Haratani T.
        • Ikeda T.
        • Hojou M.
        • Fujioka Y.
        • Araki S.
        Association of active and passive smoking with sleep disturbances and short sleep duration among Japanese working population.
        Int J Behav Med. 2008; 15: 81-91
        • Pamuk O.N.
        • Donmez S.
        • Cakir N.
        The frequency of smoking in fibromyalgia patients and its association with symptoms.
        Rheumatol Int. 2009; 29: 1311-1314
        • Punnett L.
        • Pruss-Ustun A.
        Estimating the global burden of low back pain attributable to combined occupational exposures.
        Am J Ind Med. 2005; 48: 459-469
        • Riedel B.W.
        • Durrence H.
        • Lichstein K.L.
        • Taylor D.J.
        • Bush A.J.
        The relation between smoking and sleep: The influence of smoking level, health, and psychological variables.
        Behav Sleep Med. 2004; 2: 63-78
        • Riihimaki H.
        • Wickstrom G.
        Predictors of sciatic pain among concrete reinforcement workers and house painters: A five-year follow-up.
        Scand J Work Environ Health. 1989; 15: 415-423
        • Rossignol M.
        • Abouelfath A.
        • Lassalee R.
        • Merliere Y.
        • Droz C.
        • Begaud B.
        • Depont F.
        • Moride Y.
        • Blin P.
        • Moore N.
        • Fourrier-Reglat A.
        The CADEUS study: Burden of nonsteroidal anti-inflammatory drug (NSAID) utilization for musculoskeletal disorders in blue collar workers.
        Brit J Clin Pharmacol. 2008; 67: 118-124
        • SAS Institute
        SAS software: Changes and enhancements through release 9.2.
        SAS Institute, Cary, NC2008
        • Shiri R.
        • Karppinen J.
        • Leino-Arjas P.
        • Solovieva S.
        • Viikari-Juntura E.
        The association between smoking and low back pain: A meta-analysis.
        Am J Med. 2010; 123: 7-35
        • Tessaro I.
        • Smith S.L.
        • Rye S.
        Knowledge and perceptions of diabetes in an Appalachian population.
        Preventing Chronic Disease – Centers for Disease Control and Prevention. 2005; 2: 1-9
        • Toomingas A.
        • Hagberg M.
        Outcome of the abduction external rotation test among manual and office workers.
        Am J Indus Med. 1991; 19: 215-227
      4. U.S. Department of Health and Human Services: The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Available at: Accessed January 16, 2011

        • Viikari-Juntura E.
        • Riihimaki H.
        Neck trouble in machine operating, dynamic physical work and sedentary work: A prospective study on occupational and individual risk factors.
        J Clin Epidemiol. 1994; 47: 1411-1422
        • Weingarten T.N.
        • Moeschler S.M.
        • Ptaszynski A.E.
        • Hooten W.M.
        • Beebe T.J.
        • Warner D.O.
        An assessment of the association between smoking status, pain intensity, and functional interference in patients with chronic pain.
        Pain Physician. 2008; 11: 643-653
        • Weingarten T.N.
        • Podduturu V.R.
        • Hooten W.M.
        • Thompson J.M.
        • Luedtke C.A.
        • Oh T.H.
        Impact of tobacco use in patients presenting to a multidisciplinary outpatient treatment program for fibromyalgia.
        Clin J Pain. 2009; 25: 39-43
        • Yoshimura K.
        • Oka Y.
        • Kamoto T.
        • Tsukamoto T.
        • Oshiro K.
        • Suzukamo Y.
        • Kinukawa N.
        • Ogawa O.
        Night-time frequency, sleep disturbance and general health-related quality of life: Is there a relation?.
        Int J Urol. 2009; 16: 96-100
        • Zhang L.
        • Samet J.
        • Caffo B.
        • Bankman I.
        • Punjabi N.M.
        Power spectral analysis of EEG activity during sleep in cigarette smokers.
        Chest. 2008; 133: 427-432
        • Zimmermann-Stenzel M.
        • Mannub J.
        • Schneider S.
        • Schiltenwolf M.
        Smoking and chronic back pain.
        Dtsch Arztebl Int. 2008; 105: 441-448