{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:10:44Z","timestamp":1760130644933,"version":"build-2065373602"},"reference-count":63,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,3]],"date-time":"2023-09-03T00:00:00Z","timestamp":1693699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Opium smoking has been a common practice in Iran for many years, with people often smoking for long hours. During the COVID-19 pandemic, there was an increase in opium smoking due to false beliefs about its protective effects against COVID-19 infection. In this study, we aimed to examine the association between the non-ergonomic positions associated with traditional opium smoking in Iran and the development of neck pain and disability, forward head posture (FHP), and hyperkyphosis (HK). In this cross-sectional, correlational study, a total of 120 individuals who smoked opium were selected based on the inclusion criteria. They were interviewed about their addiction profile using the Lite version of the Addiction Severity Index and the Leeds Dependence Questionnaire. The presence of neck pain and disability was also evaluated using the Visual Analog Scale and the Neck Disability Index. The participants were examined for FHP via side-view photography and for HK using a flexible ruler. Data were analyzed using correlation coefficient tests and stepwise linear regression analysis. Based on the results, homelessness, the lifetime duration of opium smoking (in months), the duration of daily opium smoking (in minutes), and the severity of drug dependence had significant relationships with the severity of neck pain, neck disability, FHP, and HK. Homelessness was the strongest predictor of neck pain and disability (R2 = 0.367, p &lt; 0.001), FHP (R2 = 0.457, p &lt; 0.001), and HK (R2 = 0.476, p &lt; 0.001), followed by the lifetime duration of opium smoking and the duration of daily opium smoking, respectively, in which R2 increased to 0.505 (p = 0.011), 0.546 (p = 0.022), and 0.570 (p = 0.004) with the addition of two other variables. Overall, an increase in the duration of sitting in non-ergonomic positions could lead to neck pain and disability, FHP, and HK due to the non-neutral posture of opium smokers.<\/jats:p>","DOI":"10.3390\/brainsci13091281","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T02:14:50Z","timestamp":1693793690000},"page":"1281","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Correlation between Neck Pain and Disability, Forward Head Posture, and Hyperkyphosis with Opium Smoking: A Cross-Sectional Study from Iran"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9688-9144","authenticated-orcid":false,"given":"Omid","family":"Massah","sequence":"first","affiliation":[{"name":"Substance Abuse and Dependence Researcher Center, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir Masoud","family":"Arab","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Farhoudian","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Tehran University of Medical Sciences, Tehran 1461884513, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Noroozi","sequence":"additional","affiliation":[{"name":"Substance Abuse and Dependence Researcher Center, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"},{"name":"Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"},{"name":"Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahimeh","family":"Hashemirad","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,3]]},"reference":[{"key":"ref_1","first-page":"75","article-title":"Addiction Is a Brain Disease","volume":"17","author":"Leshner","year":"2001","journal-title":"Issues Sci. Technol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1038\/s41386-020-00950-y","article-title":"Addiction as a brain disease revised: Why it still matters, and the need for consilience","volume":"46","author":"Heilig","year":"2021","journal-title":"Neuropsychopharmacology"},{"key":"ref_3","unstructured":"UNODC (2023, June 23). World Drug Report 2022. Vienna, Austria: (United Nations Publication, 2022). Available online: https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/world-drug-report-2022.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e2074","DOI":"10.17795\/ijpbs2074","article-title":"Iranian Common Attitude Toward Opium Consumption","volume":"9","author":"Zarghami","year":"2015","journal-title":"Iran. J. Psychiatry Behav. Sci."},{"key":"ref_5","unstructured":"Rafiey, H., Alipour, F., Madani, S., and Narenjiha, H. (2018). Rapid Situation Assessment of Drug Abuse in Iran, 2018, Department of Research and Education, Drug Control Headquarters."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"281","DOI":"10.31887\/DCNS.2017.19.3\/mpotenza","article-title":"Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions","volume":"19","author":"Potenza","year":"2022","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_7","first-page":"66","article-title":"Addiction and COVID-19 Disease: Risks and Misconceptions","volume":"13","author":"Mahdavi","year":"2021","journal-title":"Addict. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1016\/S0140-6736(18)32225-6","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990\u20132017, a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Stanaway","year":"2018","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12955-016-0439-1","article-title":"Many correlates of poor quality of life among substance users entering treatment are not addiction-specific","volume":"14","author":"Muller","year":"2016","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/nutrit\/nuaa095","article-title":"Nutritional status and eating habits of people who use drugs and\/or are undergoing treatment for recovery: A narrative review","volume":"79","author":"Mahboub","year":"2020","journal-title":"Nutr. Rev."},{"key":"ref_11","first-page":"4184190","article-title":"The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review","volume":"2018","author":"Haddad","year":"2018","journal-title":"J. Environ. Public Health"},{"key":"ref_12","unstructured":"Regavim, R.B. (2012). The Most Sovereign of Masters: The History of Opium in Modern IRAN, 1850\u20131955, University of Pennsylvania."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ghiabi, M. (2019). Drugs Politics: Managing Disorder in the Islamic Republic of Iran, Cambridge University Press.","DOI":"10.21428\/cb6ab371.aeaf3a99"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3233\/WOR-162262","article-title":"Association between postures and work-related musculoskeletal discomforts (WRMD) among beverage bottling workers","volume":"54","author":"Abaraogu","year":"2016","journal-title":"Work"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Balogh, I., Arvidsson, I., Bj\u00f6rk, J., Hansson, G.-\u00c5., Ohlsson, K., Skerfving, S., and Nordander, C. (2019). Work-related neck and upper limb disorders\u2013quantitative exposure\u2013response relationships adjusted for personal characteristics and psychosocial conditions. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2491-6"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/S0140-6736(18)32335-3","article-title":"Global, regional, and national disability-adjusted life-years (DALY) for 359 diseases and injuries and health life expectancy (HALE) for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Cooper","year":"2018","journal-title":"Lancet"},{"key":"ref_17","unstructured":"GBD 2017 DALYs and HALE Collaborators (2017). Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 390, 1260\u20131344."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.2340\/16501977-0204","article-title":"Stretching to Reduce Work-Related Musculoskeletal Disorders: A Systematic Review","volume":"40","author":"Vieira","year":"2008","journal-title":"J. Rehabil. Med."},{"key":"ref_20","first-page":"167","article-title":"Musculoskeletal disorders (MSDs)-consequences of prolonged static postures","volume":"4","author":"Anghel","year":"2007","journal-title":"J. Exp. Med. Surg. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1539\/joh.49.152","article-title":"Workers\u2019 Perception of the Changes of Work Environment and its Relation to the Occurrence of Work-Related Musculoskeletal Disorders","volume":"49","author":"Lee","year":"2007","journal-title":"J. Occup. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"52","DOI":"10.11594\/banrj.02.02.04","article-title":"Literature Review: Effect of Static Conditions on Musculoskeletal Disorders (MSDs)","volume":"2","author":"Diana","year":"2021","journal-title":"Basic Appl. Nurs. Res. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e174947","DOI":"10.1001\/jamasurg.2017.4947","article-title":"Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis","volume":"153","author":"Epstein","year":"2018","journal-title":"JAMA Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1023\/A:1016647923501","article-title":"Understanding Work-Related Upper Extremity Disorders: Clinical Findings in 485 Computer Users, Musicians, and Others","volume":"11","author":"Pascarelli","year":"2001","journal-title":"J. Occup. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1177\/0018720820983635","article-title":"Neck Strength and Endurance and Associated Personal and Work-Related Factors","volume":"64","author":"Chowdhury","year":"2022","journal-title":"Hum. Factors"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jsr.2004.12.001","article-title":"Physical limitations and musculoskeletal complaints associated with work in unusual or restricted postures: A literature review","volume":"36","author":"Gallagher","year":"2005","journal-title":"J. Saf. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5604\/20831862.1127286","article-title":"Comparison of posture among adolescent male volleyball players and non-athletes","volume":"32","author":"Grabara","year":"2015","journal-title":"Biol. Sport"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.1016\/j.scispo.2013.04.003","article-title":"Comparison of sagittal lumbar curvature between elite cyclists and non-athletes","volume":"28","author":"Muyor","year":"2013","journal-title":"Sci. Sports"},{"key":"ref_29","unstructured":"Bagherian, S., Rahnama, N., and Mahmudi, F. (2011, January 13). Investigation of Curves of the spinal cord of the table tennis athletes. Proceedings of the 6th National Conference on Physical Education Students, Tehran, Iran."},{"key":"ref_30","first-page":"582","article-title":"Comparing selected spinal column postural abnormalities of professional and amateur Wushu athletes with those of non-athletes","volume":"8","author":"Sadeghi","year":"2012","journal-title":"J. Res. Rehabil. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1017\/S2045796017000622","article-title":"Aligning the ICD-11 classification of disorders due to substance use with global service needs","volume":"27","author":"Poznyak","year":"2018","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_32","first-page":"432","article-title":"Work-Related Musculoskeletal Disorders in Truck Drivers and Official Workers","volume":"53","author":"Abolfazl","year":"2015","journal-title":"Acta Medica Iran."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.bone.2019.03.002","article-title":"Murine models of accelerated aging and musculoskeletal disease","volume":"125","author":"Hambright","year":"2019","journal-title":"Bone"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1080\/10803548.2018.1501238","article-title":"Work-related musculoskeletal problems and associated factors among office workers","volume":"26","author":"Besharati","year":"2020","journal-title":"Int. J. Occup. Saf. Ergon."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1758-2555-3-22","article-title":"Effect of Body Mass Index on work related musculoskeletal discomfort and occupational stress of computer workers in a developed ergonomic setup","volume":"3","author":"Sethi","year":"2011","journal-title":"Sports Med. Arthrosc. Rehabil. Ther. Technol."},{"key":"ref_36","first-page":"141","article-title":"Text neck syndrome-systematic review","volume":"3","author":"Neupane","year":"2017","journal-title":"Imp. J. Interdiscip. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.drugalcdep.2006.09.002","article-title":"Initial evidence for the reliability and validity of a \u201cLite\u201d version of the Addiction Severity Index","volume":"87","author":"Cacciola","year":"2007","journal-title":"Drug Alcohol Depend."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"91","DOI":"10.32598\/irj.17.2.91","article-title":"The Validity and Reliability of the Persian Version of the Leeds Dependence Questionnaire","volume":"17","author":"Massah","year":"2019","journal-title":"Iran. Rehabil. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/AJP.0000000000000999","article-title":"A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People with Neck Pain","volume":"38","author":"Modarresi","year":"2022","journal-title":"Clin. J. Pain"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E825","DOI":"10.1097\/BRS.0b013e31815ce6dd","article-title":"Translation and Validation Study of the Iranian Versions of the Neck Disability Index and the Neck Pain and Disability Scale","volume":"32","author":"Mousavi","year":"2007","journal-title":"Spine"},{"key":"ref_41","first-page":"e27696","article-title":"Reliability and Validity of Non-radiographic Methods of Forward Head Posture Measurement: A Systematic Review","volume":"14","author":"Mylonas","year":"2022","journal-title":"Cureus"},{"key":"ref_42","first-page":"18","article-title":"The Validity and Reliability of Measurement of Thoracic Kyphosis Using Flexible Ruler in Postural Hyper Kyphotic Patients","volume":"4","author":"Karimi","year":"2003","journal-title":"Arch. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1007\/s13679-017-0256-9","article-title":"Screen Time, Other Sedentary Behaviours, and Obesity Risk in Adults: A Review of Reviews","volume":"6","author":"Biddle","year":"2017","journal-title":"Curr. Obes. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/1403494811435493","article-title":"Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006","volume":"40","author":"Sun","year":"2012","journal-title":"Scand. J. Public Health"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"van Laere, I., de Wit, M., and Klazinga, N. (2009). Shelter-based convalescence for homeless adults in Amsterdam: A descriptive study. BMC Health Serv. Res., 9.","DOI":"10.1186\/1472-6963-9-208"},{"key":"ref_46","first-page":"11","article-title":"The Study of Posture and Aerobic Power of Addicts","volume":"3","author":"Daneshmandi","year":"2007","journal-title":"J. Appl. Exerc. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1080\/00140139408963688","article-title":"What do we mean by a \u2018working posture\u2019?","volume":"37","author":"Haslegrave","year":"1994","journal-title":"Ergonomics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/ajim.20750","article-title":"Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies","volume":"53","author":"Vieira","year":"2010","journal-title":"Am. J. Ind. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3233\/WOR-2010-0979","article-title":"Musculoskeletal disorders of the neck and shoulder in the dental professions","volume":"35","author":"Morse","year":"2010","journal-title":"Work"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e12269","DOI":"10.1002\/1348-9585.12269","article-title":"Dentists have a high occupational risk of neck disorders with impact on somatosensory function and neck mobility","volume":"63","author":"Zhou","year":"2021","journal-title":"J. Occup. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3233\/BMR-2012-0343","article-title":"Work related neck pain in Iranian dentists: An epidemiological study","volume":"26","author":"Rahmani","year":"2013","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1136\/oem.60.7.475","article-title":"Work related and individual predictors for incident neck pain among office employees working with video display units","volume":"60","author":"Korhonen","year":"2003","journal-title":"Occup. Environ. Med."},{"key":"ref_53","first-page":"19","article-title":"Prevalence of forward head posture in electronic gamers and associated factors","volume":"2","author":"Ashok","year":"2020","journal-title":"Int. J. Aging Health Mov."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1007\/s12178-019-09594-y","article-title":"The Relationship Between Forward Head Posture and Neck Pain: A Systematic Review and Meta-Analysis","volume":"12","author":"Mahmoud","year":"2019","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_55","first-page":"30","article-title":"The Prevalence of Musculoskeletal Pain and Forward Head Posture among Heroin Users during their Withdrawal with Methadone","volume":"6","author":"Motiallah","year":"2014","journal-title":"Addict Health"},{"key":"ref_56","first-page":"162","article-title":"Comparison of forward head in persons with chronic neck pain and healthy persons","volume":"7","author":"Taheri","year":"2011","journal-title":"J. Res. Rehabil. Sci."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Alexopoulos, E.C., Stathi, I.-C., and Charizani, F. (2004). Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet. Disord., 5.","DOI":"10.1186\/1471-2474-5-16"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10773525.2018.1547507","article-title":"Prevalence and risk factors of musculoskeletal disorders among farmers involved in manual farm operations","volume":"24","author":"Jain","year":"2018","journal-title":"Int. J. Occup. Environ. Health"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/10803548.2021.2021712","article-title":"Risk factors of neck disability in computer-using office workers: A cross-sectional study","volume":"29","author":"Korkmaz","year":"2023","journal-title":"Int. J. Occup. Saf. Ergonomics"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Wang, J., Cui, Y., He, L., Xu, X., Yuan, Z., Jin, X., and Li, Z. (2017). Work-Related Musculoskeletal Disorders and Risk Factors among Chinese Medical Staff of Obstetrics and Gynecology. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14060562"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"111133","DOI":"10.1016\/j.nut.2020.111133","article-title":"Evaluation of muscle-skeletal strength and peak expiratory flow in severely malnourished inpatients with anorexia nervosa: A pilot study","volume":"85","author":"Dicembre","year":"2021","journal-title":"Nutrition"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/occmed\/49.3.155","article-title":"Smoking, heavy physical work and low back pain: A four-year prospective study","volume":"49","author":"Eriksen","year":"1999","journal-title":"Occup. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1038\/nrendo.2010.146","article-title":"Hypovitaminosis D in developing countries\u2014Prevalence, risk factors and outcomes","volume":"6","author":"Arabi","year":"2010","journal-title":"Nat. Rev. Endocrinol."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/9\/1281\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:45:49Z","timestamp":1760129149000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/9\/1281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,3]]},"references-count":63,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["brainsci13091281"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13091281","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2023,9,3]]}}}