While previous studies have suggested links between smoking and pain, especially chronic back pain, most of these studies did not factor out lifestyle factors, such as on-the-job manual labor, as a possible contributing cause.
The present study consisted of questions about pain in the low back, neck, and upper and lower limbs during the past 12 months; smoking habits; physical activities at work; headaches; and tiredness or stress. 12,907 subjects, including 6,513 who had smoked at some time, among whom 3,184 were current smokers, completed questionnaires. Smoking habits were related to age, social class, report of headaches, tiredness or stress, and manual activities at work.
The survey found that smokers complain more often of discomforting or disabling musculoskeletal pain than never-smokers. They found that, compared with those who had never smoked, current smokers had about a 50% higher incidence of reporting pain in the past year preventing activity, meaning pain so severe it precluded the individual from going to work or performing housework or hobby activities.
Pain at all sites--lower back, shoulders, elbows, hands, neck and knees--was higher in smokers, even ex-smokers, than people who never smoked. What's more, this association held in both those who had physically demanding jobs as well as those who had white-collar or other jobs that did not require heavy lifting or moving. Since the association was found even in ex-smokers, this suggests that smoking may, according to the researchers, cause long-term damage to muscle tissues or changes in the neurological pain response.
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