{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:55:32Z","timestamp":1792806932998,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low back pain (LBP) is a predominant cause of disability, imposing a significant burden on healthcare systems and individuals' quality of life. The multifactorial nature of LBP encompasses various risk factors, but the association between smoking and LBP, particularly concerning severity and disability, has not been fully explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilised a cross\u2010sectional design with propensity score matching to analyse the relationship between smoking and LBP severity and associated disability among adults aged 18 to 64. We prospectively recruited individuals from the general public, assessing LBP severity and disability using the von Korff questionnaire and the Roland Morris Disability Scale (RMDS). Smoking status was classified as \u2018yes\u2019 or \u2018no\u2019 and further stratified by pack years (PY). Adjustments were made for age, sex, body mass index (BMI), alcohol consumption, physical activity, and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 430 patients with a median age of 41 (IQR 31\u201353) were included in the analysis, with 79 (18.4%) being active smokers. In the propensity score\u2010matched analysis, individuals with 0 to &lt;\u200910 PY did not show a significant increase in pain\u2010related outcomes, whereas those with \u2265\u200910 PY exhibited a significant increase in pain severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043), disability score (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), and RMDS score (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). Multivariable linear regression further confirmed a significant association between PY and LBP\u2010related outcomes, whereas smoking status alone was not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study shows an independent effect of smoking on disability and pain severity, underscoring the potential importance of smoking cessation in LBP management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This study identified a dose\u2013response relationship between smoking and increased low back pain (LBP) severity and disability, particularly among individuals with \u2265\u200910 pack years, strengthened by the robust propensity score\u2010matched design. By highlighting the independent effect of smoking on pain and disability, these findings emphasise the role of Smoking in the development of LBP and the potential importance of smoking cessation as a critical component in managing LBP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70041","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T12:09:04Z","timestamp":1747742944000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Impact of Smoking on Low Back Pain and Disability"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0743-8860","authenticated-orcid":false,"given":"Lukas","family":"Sch\u00f6nnagel","sequence":"first","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard U.","family":"Hoehl","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima","family":"Taheri","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Becker","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Suwalski","sequence":"additional","affiliation":[{"name":"Medical Heart Center of Charit\u00e9 CBF \u2013 Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Sch\u00f6mig","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"},{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"K\u00f6hli","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute Berlin Institute of Health at Charit\u00e9 \u2013 Universi\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Pumberger","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2005.05.034"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.34172\/hpp.2021.50"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2021.06.037"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00098-X"},{"key":"e_1_2_8_6_1","first-page":"S31","article-title":"The STROBE Guidelines","volume":"13","author":"Cuschieri S.","year":"2019","journal-title":"Saudi Journal of Anesthesia"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0136137"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.08.018"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-064119"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532-2149.2012.00277.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2020.02.47"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200004150-00016"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/antiox9111166"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1680-7"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2023.0159"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000932"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001631"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00733-9"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.50.6.613"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph6010209"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-8-115"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2022.100916"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198303000-00004"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1020363010465"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.05.028"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnz224"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(45)90210-9"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1214\/09-STS313"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00133-9"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s007760100067"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(92)90154-4"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61729-2"},{"key":"e_1_2_8_33_1","volume-title":"WHO Guideline for Non\u2010Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings","author":"WHO","year":"2023"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13013-017-0121-3"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1081706"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.13.04152"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20054217"}],"container-title":["European Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.70041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T04:44:03Z","timestamp":1764477843000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejp.70041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ejp.70041"],"URL":"https:\/\/doi.org\/10.1002\/ejp.70041","archive":["Portico"],"relation":{},"ISSN":["1090-3801","1532-2149"],"issn-type":[{"value":"1090-3801","type":"print"},{"value":"1532-2149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]},"assertion":[{"value":"2024-10-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70041"}}