title: Negative effects of smoking, workers' compensation, and litigation on pain/disability scores for spine patients.
abstract: BACKGROUND
  When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compensation, and litigation on disability and pain scores.
  
  
  METHODS
  With Institutional Review Board approval, the medical records of 13,704 consecutive patients with spinal disorders treated at two university spine centers were reviewed. Particular attention was focused on the pretreatment impact of three variables: smoking, workers compensation, and litigation. All patients completed a questionnaire that included a modified Oswestry Disability Index (ODI), a visual analog pain scale (VAS) and a history of smoking, workers compensation, and/or litigation issues. Analysis of Variance (ANOVA) with Bonferroni (when appropriate) was used to analyze the data.
  
  
  RESULTS
  ODI SCORES SIGNIFICANTLY CORRELATED WITH A SMOKING HISTORY: Current Smoker > Previous Smoker > Never Smoked (44.22 > 38.11 > 36.02, respectively). Pain scores and ODI scores had a direct correlation to workers compensation and litigation status. Workers compensation, litigation and smoking combined created even higher scores. There was no significant difference between previous smokers and nonsmokers.
  
  
  CONCLUSIONS
  This study demonstrates that a history of smoking, workers compensation, and/or litigation, considered alone or worse, combined, negatively impacted outcomes for patients seeking treatment at our spine centers. For optimal outcomes in spine patients, cessation of smoking and treatment of attendant psychological and social factors prove critical.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Texas Health Science Center, Ironman Sports Medicine Institute, Houston, TX, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Prasarn
authors.forename: Mary B
authors.initials: MB
authors.lastname: Horodyski
authors.forename: Caleb
authors.initials: C
authors.lastname: Behrend
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Rechtine