Smoking linked to back pain

New research suggests that smoking can increase your risk of back pain.

In a study of 95,000 nurses, women who smoked were three times more likely to develop arthritis. This inflammatory arthritis causes pain in  the low back and sacrum. Past smokers were 1 and a half times more likely to develop arthritis, and women who smoked for over 25 years had the highest risk of all. Researchers suggested that smokers may be more susceptible to arthritis because smoking could induce oxidative stress that causes inflammation and harms the immune system.

In another new study, smokers were more likely to have an early onset of inflammatory back pain. Compared to non-smokers, patients who smoked had greater disease activity, worse function, and a poorer quality of life. MRI scans revealed that smokers were also more likely to have structural lesions on their spines and sacroiliac joints. More severe symptoms forced smokers to miss work more often than nonsmokers. Researchers recommended that patients with inflammatory back pain be “strongly advised” to quite smoking.

If  you suffer from back pain, your chiropractor can ease your pain while supporting you in making healthy lifestyle choices to reduce pain and improve your overall health. Call our office to learn more.


Chung HY, Machado P, Heijde D, et al. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort.Annals of the Rheumatic Diseases 2012;71:809-816. doi:10.1136/annrheumdis-2011-200180.

Li W, Han J, Qureshi A. Smoking and risk of incident psoriatic arthritis in US women. Annals of the Rheumatic Diseases 2012;71:804-808. doi 10.1136/annrheumdis-2011-200416.

Walsh, Nancy. Smoking Tied to Back Pain, Arthritis. Medpage Today. May 18,2012. Accessed May 24, 2012.

Rheumatoid Arthritis Articles


Emotional Disclosure in Rheumatoid Arthritis Patients

Numerous studies have documented that psychological issues play a role in pain conditions, although the exact nature of this relationship is not well understood.

In this study, researchers took a group of 36 rheumatoid arthritis (RA) patients, and had them talk privately into a tape recorder about a stressful event in their lives (the Disclosure group). Another 36 RA patients were asked to talk about trivial topics (the Control group). Both groups participated in these activities for four consecutive days, and the researchers measured pain levels and psychological functioning. The RA patients were also evaluated at two weeks and at four months after the experiment.

The Disclosure patients were found to have significantly increased negative mood reactions immediately after the disclosure period—especially on scales of Dejection/Depression, Anger/Hostility, and Fatigue/Inertia. No such trend was found in the Control patients.

The authors found that disclosure did not have an effect on pain. However,Disclosure patients did show significantly reduced emotional dysfunction and increased general health over a period of four months, as compared to the Control group patients.

The authors explain the role of emotions and physical health as such:

“The effects of a stressful experience appear to be mediated by one’s emotional processing of the event. Although the normal response to a stressful event is a complex process that may involve both avoidance and intrusion of memories, most theorists agree that excessive avoidance, or prolonged and rigid inhibition of negative memories, prevents the reappraisal, reintegration, and eventual resolution of the experience…Because inhibition requires effort, chronic psychological arousal may occur, potentially leading to physical symptoms, autonomic and immune dysfunction, and disease. In contrast, volitional and repeated exposure to distressing memories permits their emotional processing and resolution, potentially yielding better subjective, behavioral, and physical health.”

The authors conclude by stating that addressing traumatic life events, as well as how the patient has inhibited emotional reactions to such traumas, is an important issue that should be considered when working with patients with RA, and perhaps other health conditions as well.

Kelley JE, Lumley MA, Leisen JCC. Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychology 1997;16(4):331-340.

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Rheumatoid Arthritis and Exercise

This recent study1 examined the effects of an 8-week dance-based exercise program in a group of 10 women with rheumatoid arthritis (RA, Class III). Previous research by the same authors had found that the EDUCIZE program, developed by arthritis researchers,2 was helpful for patients with Class I and II RA. The subjects in this study had a mean age of 54 years.

Both before and after the 8-week program, all participants were carefully evaluated in regard to health status, use of medications, joint pain and swelling, cardiorespiratory fitness, daily activity, and psychological status.

The researchers found that while there was no significant increase in aerobic power, there were other benefits. Social activity increased, and depression, anxiety, anger, and tension decreased after the experimental period. “Many of [the patients] reported significant improvements in stability, improved mobility, and a decrease in pain and stiffness.”

Most importantly, no aggravation of joint pain or swelling was found in the participants.

  1. Noreau L, Moffet H, Drolet M, Parent E. Dance-based exercise program in rheumatoid arthritis. American Journal of Physical Medicine and Rehabilitation 1997;76(2):109-113.
  2. Perlman SG, Connell K, Clark A, et al. Dance-based aerobic exercise for rheumatoid arthritis. Arthritis Care Research 1990;3:29-35.

Overdiagnosis of Fibromyalgia

As fibromyalgia (FM) has gained wider acceptance and awareness in the medical community, this study inquired if any overdiagnosis of the disease occurred in a group of 321 women in a rheumatology clinic. Over a one-year period, 35 patients were diagnosed with FM.

An additional 11 women had received a presumed diagnosis of FM when in fact their condition was unrecognized spondyloarthropathy.

The authors hypothesize on the misdiagnosis. There is an evident overlap in symptoms between the two conditions. The authors compare the two:

“Both conditions frequently present with a long history of ongoing ill-defined pain, associated with sleep disturbance and prominent symptoms on awakening. However, the intensity and localization of spinal pain to fairly specific sites in the neck, midthoracic, anterior chest wall, or lumbar regions in the patients with spondyloarthropathy is somewhat different from the diffuse and ill-definedmuscular pain of FM. Although both illnesses cause sleep disturbance, our patients reported prominent night spinal pain that awakened them from sleep, rather than a complaint of simply restless sleep. Nine of the 11 spondyloarthropathy patients had inflammatory type pain involving at least 2 of these sites.”

The authors noted that spondyloarthritis has a prolonged course, evolving over 10 years. However, radiological changes of sacroilitis may not be apparent at onset or over time. Therefore, physicians can not be reliant on radiological sacroiliitis for diagnosis. The researchers report, “In a 10 year follow up study of 54 patients presenting with inflammatory type spinal pain, all of whom lacked radiological sacroiliitis at study entry, 32 were finally diagnosed with definite ankylosing spondylitis, and a further 10 with possible or undifferentiated sponyloarthropathy.”
The authors stress that FM diagnosis does not exclude the possibility of other conditions causing the same symptoms. “Now that FM is an accepted diagnosis, it is possible that it may be used too freely in patients with ill-defined pain.”

Fitzcharles MA, Esdaile JM. The overdiagnosis of fibromyalgia syndrome. American Journal of Medicine 1997;103:44-50.

Whiplash Injury, Neck Ligaments Weakened

This study is important, because it shows that the ligaments of the cervical spine are weakened after even a “minor” auto collision. This weakening of the integrity of the cervical spine can result in abnormal motion of the spine, pain, and premature degeneration of the vertebral joints – more commonly known as osteoarthritis.

After years of study, it is clear that the spinal ligaments can be stretched or torn during an auto collision. Previous studies have shown that the anterior longitudinal ligaments, the transverse ligaments, and the facet capsules can be damaged, even in “minor” crashes.

The scientific consensus is this: during an auto collision, the individual vertebrae of the spine move so rapidly and so extremely, the ligaments that hold the spine together are sprained.Whiplash weakens the neck

A new study from Yale University has taken an important new step in understanding the exact nature of these injuries. First, the researchers started with six cadaver spines that they had previously exposed to simulated rear end collisions. They took these spines apart and tested the failure point of each of the individual ligaments. They then compared the failure rate of the whiplash spinal ligaments to previously collected data on normal, non-injured spines.

The authors studied four different characteristics of the ligaments: failure force, elongation, energy absorbed, and stiffness. The data from the whiplash-exposed ligaments was then compared to the control ligaments.

The authors found that the whiplash ligaments were significantly weaker than the control specimens:

“The present study determined the dynamic failure properties of whiplash-exposed human cervical spine ligaments and compared the results with previously reported control data. Significant decreases in ligament strength were observed following whiplash, supporting the ligament-injury hypothesis of whiplash syndrome. Clinical studies, which have documented pain relief in whiplash patients following nerve block and radiofrequency ablation of facet joint afferents provide support for the present results which indicate whiplash loading causes decreased ligament strength.”

The study provides a suggested sequence of events that may occur after injury to the ligaments that can cause chronic pain and disability after a collision:

  1. The violent stretching of the ligaments causes subfailure injuries to the ligaments and nerve receptors in the ligaments.
  2. This weakening of the ligaments may lead to altered joint motion and loading patterns, compressing the joint tissues.
  3. This compression can result in inflammation, pain, and accelerated degeneration of the joint tissue, resulting in osteoarthritis of the neck.

This study is the first to show that the individual ligaments of the spine are weakened after a whiplash-type motion. Clinically, it is important to carefully measure range of motion and to use flexion/extension radiographs in these patients to help pinpoint those areas of the spine that have been injured.

Tominaga Y, Ndu AB, Coe MP, et al. Neck ligament strength is decreased following whiplash trauma. BMC Musculoskeletal Disorders 2006;7:103.

Musculoskeletal Medicine and Primary Care Physicians

Musculoskeletal difficulties or injuries rate as the second most common reason for patients to consult with their primary care doctor. Yet, questions have been raised about the quality of primary care doctors’ knowledge of fundamental musculoskeletal medicine. This study surveyed 85 recent medical school graduates in their first year of residency to determine their competency in musculoskeletal health, and to gain some background knowledge of their musculoskeletal health education while at medical school.

The test was administered at the Hospital of the University of Pennsylvania, and was designed by an orthopedic surgeon who was not involved in the study. The questions revolved around topics and concerns encountered frequently in a general practice, such as fractures and dislocations, low back pain, and arthritis. With questions such as, “Name two differences between rheumatoid arthritis and osteoarthrosis,” and, “A patient has a displaced fracture near the fibular neck. What structure is at risk for injury?” the 25 questions covered the fundamentals of musculoskeletal medicine. The authors then sent the exam to 124 chairpersons of orthopedic residency programs in the US, asking them to rate the importance of each question and suggest a passing score that would demonstrate basic competency. The accepted mean passing score was 73.1%.

70 of 85 (82%) graduates failed the exam:

“The current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine. The duration of the residents’ preparation in this area was inadequate. For the study population as a whole, the mean duration of instruction in orthopaedics was only 2.1 weeks. In addition, twenty-eight residents (33 percent) had graduated from medical school with no rotation, required or elective, in orthopaedic surgery; these residents had the lowest mean score (55.9%) on the examination and the highest rate of failure (93%).”

Medical school is generally the only training in musculoskeletal medicine. Furthermore, the prestigious school roster represented in the sample of graduates—Cornell University Medical College, Harvard Medical School, University of Chicago, the Schools of Medicine of John Hopkins University, and New York University as well as numerous other institutions–causes alarm due to the evident inadequacy in this area of training. The authors call for reform:

“Our findings suggest the need for two educational reforms: an increase in instructional time and a revision of the content of the curriculum…An ideal required rotation in musculoskeletal medicine would be at least two weeks in duration and would emphasize common outpatient orthopaedic problems, orthopaedic emergencies, and physical examination for musculoskeletal problems.”

Freedman K and Bernstein J. The adequacy of medical school education in musculoskeletal medicine. The Journal of Bone and Joint Surgery 1998; 80-A(10):1421-1427.

5 Tips for Fighting Cold Weather Pain Video

If a drop in temperature makes your pain levels soar, you’re not alone: many people with chronic pain conditions like arthritis and fibromyalgia find that their symptoms worsen during the winter.

We don’t know exactly why cold weather exacerbates pain but one leading theory blames changes in barometric pressure. As the cold sets in, reduced air pressure causes the tissues within the joints to expand, causing an already inflamed joint to become even more swollen and painful.
Although the link between cold weather and chronic pain is still not fully understood, doctors have developed ways to cope with increased pain in the winter.

Here are five easy tips for fighting cold weather pain:

1. Exercise

Rainy, snowy weather may discourage you from getting outside to exercise but that can actually increase your pain and stiffness. Regular physical activity can help you maintain flexible, functioning joints and muscles. Exercise can also improve your mood.

2. Boost Your Mood

Some theories argue that dreary weather results in mood changes that make you more susceptible to pain. Addressing feelings of anxiety and depression could help ameliorate pain.

3. Stay hydrated

Without the warm weather, many people just don’t feel as thirsty and forget to drink enough water. That can prevent the body from properly processing waste, making you feel more achy. Try carrying a water bottle and limiting your caffeine intake.

4. Heat Therapy

Beyond bundling up and staying warm, you can use heating pads to soothe sore muscles and joints.

5. Visit Your Chiropractor

Chiropractic adjustments can keep your spine and joint functioning well throughout the winter months. Studies show that chiropractic can alleviate symptoms of osteoarthritis, fibromyalgia, migraine, headache, as well as chronic neck and back pain.

A 2011 study suggested that chiropractic adjustments can ease stress hormones, which may help with mood changes tied to cold weather.1 Your chiropractor can also provide recommendations on using heat and exercise therapies for relieving pain.

Finally, remember that cold weather doesn’t mean you have to suffer. Contact our office to see how we can make your winter as pain-free as possible.


1. Ogura, Takeshi and Manabu Tashiro, Mehedi,Shoichi Watanuki, Katsuhiko Shibuya, Keiichiro Yamaguchi, Masatoshi Itoh, Hiroshi Fukuda, Kazuhiko Yanai. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Alternative Therapies. 2011; 17 (6): 12-17.

Jaw Pain

Pain in the jaw area is often caused by a dislocation of the joint, known as TMJ. The pain can be caused by an injury, like an auto accident, or by long-term degeneration. Learn more about how a chiropractor can help relieve jaw pain.

Whiplash Symptoms – TMJ or Jaw Pain


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