TOBACCO AND MUSCULOSKELETAL PAIN MiniLecture 1 Module Tobacco

TOBACCO AND MUSCULOSKELETAL PAIN Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

Objectives of the Mini Lecture Goal of Mini Lecture: Provide students with knowledge about the effects of tobacco on musculoskeletal pain. Learning Objectives: Students will be able to: • Understand the relationship between tobacco use and back pain and understand the mechanism by which this occurs. • Discuss the relationship between tobacco and osteoporosis. • Review the effects of smoking on bone mineral density and the risk of fractures. • Understand the benefits of cessation in relation to bone loss and risk of hip fracture.

Contents Core Slides 1. Tobacco and Back Pain 2. How Smoking Causes Back Pain (1– 2) 3. Tobacco and Osteoporosis 4. Smoking and Bone Mineral Density 5. Smoking and Fractures 6. Benefits of Smoking Cessation Optional Slides 1. Other Musculoskeletal Conditions 2. Bone Mineral Density 3. Bone Density and Age 4. Risk of Hip Fracture and Age

CORE SLIDES Tobacco and Musculoskeletal Pain Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

Tobacco and Back Pain Any Tobacco Use: • Non-specific back pain in men and women 1 • Both high and low-back pain 2 Smoking: • Exacerbates back pain 3 • Greater impact on persons with damaged spines 3 • Risk factor for pain 3, 4 www. topnews. in/health/files/back-pain. jpg 1. Goldberg et al. 2000; 2. Mattila et al. 2008; 3. Scott et al. 1999; 24: 1090 4. Ernst 1993

How Smoking Causes Back Pain (1) • Smoker’s cough Increases intra-discal pressure Sciatica and herniated discs 1 • Mechanism: Carboxy-haemoglobin formation nicotine -induced vasoconstriction arterio-sclerotic vessel wall changes impairment of fibrinolytic activity and changes in the flow properties of blood Malnutrition of disc renders it more vulnerable to mechanical stress. 2 1. Ernst 1993; 2. Palmer et al. 2003

How Smoking Causes Back Pain (2) • Frequent coughing and concurrent unhealthy life style (unhealthy diet, lack of exercise, use of alcohol) predispose to back pain 1 • Affects neurological processing of sensory information or nutrition of peripheral tissues 2 • People with a low pain and disability threshold: more likely to take up and continue smoking 2 1. Ernst 1993; 2. Palmer et al. 2003

Tobacco and Osteoporosis • Smoking 1 and smokeless tobacco use: 2 risk factor for osteoporosis • Mechanisms of osteoporosis: 3, 4 • Early menopause • Decreased 25 hydroxyvitamin D • Decreased calcium absorption • Calcitonin resistance • Hormone Replacement: Ineffective in postmenopausal women smokers 1 http: //www. nlm. nih. gov/MEDLINEPLUS/ency/imagepages/17287. htm 1. Ill et al. 1993; 2. Quandt et al. 2005; 3. Tziomalos et al. ; 4. Conrad (no date)

Smoking and Bone Mineral Density http: //www. pitt. edu/~kaf 24/index. html • Smokers greater rates of bone loss over time 1 • Significant bone mass differences between the two groups 1 1. Ward and Klesges 2001

Smoking and Fractures http: //www. hughston. com/hha/a_11_4_1. htm • Tobacco smoking: Independent risk factor for hip fracture and increased lifetime fracture risk (women: 31% & men: 40%). 1 • Also increased lifetime risk of developing vertebral fracture (women: 13% & men: 32%). 2 1. Høidrup et al. 2000; 2. Law and Hackshaw 1997

Benefits of Smoking Cessation • Smoking has a dose-dependent effect on bone loss increases fracture risk (may be partially reversed by smoking cessation). 1 • Smoking cessation decreased risk of hip fractures in men after 5 years; however, effect is more long-lasting in female ex-smokers. 1 1. Law and Hackshaw 1997

OPTIONAL SLIDES Tobacco and Musculoskeletal Pain Mini-Lecture 1 Module: Tobacco and the Musculoskeletal System

Other Musculoskeletal Conditions 1 Smoking causes increased risk of: • Osteo-necrosis femoral head • Non-union • Adverse effect on arthrodesis • Rheumatoid arthritis in twins • Dupuytren’s contracture • Reflex sympathetic dystrophy http: //www. eorthopod. com/public/patient_education/6622/sac roiliac_joint_dysfunction. html 1. Conrad, http: //www. orthosmoke. org/ortho. Smoke. pdf

Bone Mineral Density (BMD) POSSIBLE MECHANISMS: HOW SMOKING LEADS TO LOW BMD ? http: //medgenmed. medscape. com/viewarticle/408508_print

Bone Density and Age Report of the Surgeon General's Workshop on Osteoporosis and Bone Health December 12 -13, 2002, Washington, D. C http: //www. surgeongeneral. gov/topics/bonehealth/workshop_report/workshop_rpt. htm

Risk of Hip Fracture and Age Report of the Surgeon General's Workshop on Osteoporosis and Bone Health December 12 -13, 2002, Washington, D. C http: //www. surgeongeneral. gov/topics/bonehealth/workshop_report/workshop_rpt. htm

The most important health message a doctor can give to patients is to quit smoking.