Back pain is now a very common phenomenon. It is caused by various pathologies in the area of the motor unit of the spine. These changes can cause pressure on the nerve structures within the spinal canal, resulting in various ailments. Pain is the most common symptom. In most cases, patients are qualified for conservative management. In the case of neurological deficits, the patient is qualified for spinal surgery. Unfortunately, surgical treatment is not always 100% effective therapy method. Moreover, many external factors, such as smoking for instance, can affect the process of tissue healing and decide on the time of recovery.

The aim of the study was to assess the impact of smoking on back pain intensity in rehabilitated patients with discopathy treated conservatively and surgically.

Material and methods:
The study included 41 patients after surgical treatment (9 smokers) and 96 patients (20 smokers) undergoing conservative therapy for back pain due to discopathy. All patients underwent a multidirectional rehabilitation programme at the Department of Rehabilitation and Physical Medicine of the Medical University in Łódź.

The Laitinen scale was used to assess the patients’ pain. Rehabilitation of patients with back pain due to discopathy had a significant analgesic effect (p <0.0001). Furthermore, there was observed a statistically significant effect of smoking on the level of pain intensity on the Laitinen scale in the group of patients who underwent surgery (p <0.0469). The smokers operated on had significantly worse results.

1) Complex rehabilitation of patients with back syndrome pain due to discopathy demonstrated significant analgesic effectiveness. 2) Smoking significantly worsens the results of the therapy in patients who underwent surgery.

Kraemer J. Choroby krążka międzykręgowego [Intervertebral disc diseases]. Wrocław: Elsevier Urban & Partner; 2012. In Polish.
Lama P, Le Maitre CL, Harding IJ, Dolan P, Adams MA. Nerves and blood vessels in degenerated intervertebral discs are confined to physically disrupted tissue. J Anat. 2018; 233: 86–97.
Koszela K, Krukowska S, Woldańska-Okońska M. [Back pain as a lifestyle disease]. Pediatr Med Rodz. 2017; 13(3): 344–351. 2017.0036 In Polish.
Czapiński J, Panek T, eds. [Social diagnosis 2015. Objective and subjective quality of life in Poland]. Contemp Econ. 2015; 9(4) [cited 2019 Oct 30].
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: a meta-analysis. Am J Med. 2010; 123(1): 87.e7–35. https://doi: 10.1016/j.amjmed.2009.05.028.
Pingot J, Pingot M, Łabecka M, Woldańska-Okońska M. [The Use of Saunders Lumbar Traction in Physiotherapy of Patients With Chronic Lower Back Pain]. Pol Med J. 2014; 36(215): 330–5. In Polish.
Thomas KC, Fisher CG, Boyd M, Bishop P, Wing P, Dvorak M. Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy. Spine. 2007; 32(13): 1414–22.
Koszela K, Krukowska S, Woldańska-Okońska M. [The assessment of the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc]. Pol Med J. 2017; 42(251): 201–204. In Polish.
Boos N, Aebi M. Choroby kręgosłupa [Spinal disorders]. Warszawa: Medipage; 2016. In Polish.
Rajaee SS, Kanim LE, Bae HW. National trends in revision spinal fusion in the USA: patient characteristics and complications. Bone Joint J. 2014; 96-B: 807–816.
Kraemer R, Herdmann J, Kraemer J. Mikrochirurgie der Wirbelsaule. Stuttgart: Thieme; 2005.
Martin B, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine. 2007; 32(3): 382–7.
Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018; 12: 574–85.
Koszela K, Krukowska S, Woldańska-Okońska M. [Impact of rehabilitation on the level of pain intensity in patients with field back surgery syndrome]. Pol Med J. 2017; 42(252): 252–255. In Polish.
Peolsson A, Hedlund R, Vavruch L, Oberg B. Predictive factors for the outcome of anterior cervical decompression and fusion. Eur Spine J. 2003; 12(3): 274–80.
McGregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 1: the assessment of outcome. Spine. 2002; 1(27): 1465–70.
McGregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine. 2002; 1(27): 1471–6.
Carragee EJ, Kim DH. A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine. 1997; 15(22): 1650–60.
Robson EK, Kamper SJ, Davidson S, et al. Healthy Lifestyle Program (HeLP) for low back pain: protocol for a randomised controlled trial. BMJ Open. 2019; 9(9): e029290. https://doi: 10.1136/bmjopen-2019-029290.
Tomczyk M, Nowak W, Jaźwa A. [Endothelium in the physiology and pathogenesis of diseases]. Postępy Biochemii. 2013; 59(4): 357–364. In Polish.