title: Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care in Geriatric Patients.
abstract: BACKGROUND
  We examined rates of smoking cessation and the effect of smoking cessation on pain and disability scores in a geriatric patient population.
  
  
  METHODS
  Prospectively maintained database records of 6779 patients treated for painful spinal disorders were examined. The mean duration of care was 8 months. Multivariate statistical analysis was performed with independent variables including smoking status, secondary gain status, gender, treatment type, depression, and age.
  
  
  RESULTS
  Of the patients seeking care for painful spinal disorders, 8.9% over the age of 55 smoked compared with 23.9% of those under 55 years of age. Rates of smoking cessation did not differ for those older than 55 years (25.1%) and younger patients (26.1%). Current smokers in both age-groups reported greater pain than those who had never smoked in all pain ratings (P < .001). Mean improvement in reported pain over the course of treatment was significantly different in nonsmokers and current smokers in both age-groups (P < .001). Those who quit smoking during the course of care reported greater improvement in pain than those who continued to smoke. The mean improvement in pain ratings was clinically significant in patients in all 3 groups of nonsmokers whereas those who continued to smoke had no clinically significant improvement in reported pain.
  
  
  CONCLUSIONS
  The results support the need for smoking cessation programs, given a strong association between improved patient-reported pain and smoking cessation. Fewer older patients smoke but they are equally likely to quit.
authors.affiliation: Carilion Clinic Orthopaedics, Viginia Tech, Roanoke, VA, USA.
authors.forename: Caleb
authors.initials: C
authors.lastname: Behrend
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA ; Technische Universität München, München, Germany.
authors.forename: Etienne
authors.initials: E
authors.lastname: Schonbach
authors.affiliation: Department of Surgery, University of Miami, Miami, FL, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Coombs
authors.affiliation: Independent Statistical Support, Rochester, NY, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Coyne
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Texas, Houston, TX, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Prasarn
authors.affiliation: Department of Orthopaedics, Veterans Affairs Hospital, St. Petersburg, FL, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Rechtine
keywords: anesthesia; biomechanics; economics of medicine; fragility fractures; geriatric medicine; nonoperative spine; spine surgery