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Wague A, O'Donnell JM, Stroud S, Filley A, Rangwalla K, Baldwin A, El Naga AN, Gendelberg D, Berven S. Association between opioid utilization and patient-reported outcome measures following lumbar spine surgery. Spine J 2024; 24:1183-1191. [PMID: 38365008 DOI: 10.1016/j.spinee.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/10/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND CONTEXT The patient-reported outcomes measurement information system (PROMIS), created by the National institute of Health, is a reliable and valid survey for patients with lumbar spine pathology. Preoperative opioid use has been shown to be an important predictor variable of self-reported health status in legacy patient-reported outcome measures. PURPOSE To investigate the impact of chronic preoperative opiate use on PROMIS survey scores. STUDY DESIGN Retrospective database analysis. PATIENT SAMPLE Between March 2019 and November 2021, 227 patients underwent lumbar decompression ± ≤ 2 level fusion. Fifty-seven patients (25.11%) had chronic preoperative opioid use. OUTCOME MEASURES Oswestry disability index (ODI) and PROMIS survey scores. METHODS A retrospective analysis of a prospectively maintained single center patient-reported outcome database was performed with a minimum of 2 year follow-up. PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative intake with subsequent follow-up at 6, 12, and 24 months postoperatively. Patients were grouped into chronic opioid users as defined by >6-month duration of use. Differences in mean survey scores were evaluated using Welch t-tests. RESULTS Two hundred and twenty-seven patients met our inclusion criteria of completed PROMIS surveys at the designated timepoints. A total of 57 (25.11%) were chronic opioid users (COU) prior to surgery. Analysis of patient-reported health outcomes shows that long term opioid use correlated with worse ODI and PROMIS scores at baseline compared to nonchronic users (NOU). At 1 and 2 year follow-up, the COU cohort continued to have significantly worse ODI, PROMIS Fatigue, PF, PI, SD, and SR scores. There is a statistical difference in the magnitude of change in health status between the 2 cohorts at 1 year follow-up in PROMIS Depression (-5.04±7.88 vs -2.49±8.73, p=.042), PF (6.25±7.11 vs 9.03±9.04, p=.019), and PI (-7.40±7.37 vs -10.58±9.87, p=.011) and 2 year follow-up in PROMIS PF (5.58±6.84 vs 7.99±9.64, p=.041) and PI (-6.71±8.32 vs -9.62±10.06, p=.032). Mean improvement in PROMIS scores for the COU cohort at 2 year follow-up exceeded minimal clinically important difference (MCID) in all domains except PROMIS Depression, SR and SD. CONCLUSION Patients with chronic opioid use status have worse baseline PROMIS scores compared with patients who had nonchronic use. However, patients in the COU cohort displayed clinically significant postoperative improvement in multiple PROMIS domains. These results show that patients with chronic opioid use can benefit greatly from surgical intervention and will allow physicians to better set expectations with their patients.
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Affiliation(s)
- Aboubacar Wague
- University of California San Francisco School of Medicine, San Francisco, CA 94143, USA.
| | - Jennifer M O'Donnell
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA
| | - Sarah Stroud
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA
| | - Anna Filley
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA
| | - Khuzaima Rangwalla
- University of California San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Avionna Baldwin
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA
| | - Ashraf N El Naga
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - David Gendelberg
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Sigurd Berven
- University of California San Francisco, Department of Orthopaedic Surgery, San Francisco, CA 94143, USA
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2
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Robinson CL, Kim RS, Li M, Ruan QZ, Surapaneni S, Jones M, Pak DJ, Southerland W. The Impact of Smoking on the Development and Severity of Chronic Pain. Curr Pain Headache Rep 2022; 26:575-581. [PMID: 35731364 DOI: 10.1007/s11916-022-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the impact of smoking and its role on the development of chronic pain and provide a critical review of recent literature. RECENT FINDINGS Recent studies demonstrate the bidirectional and dependent relationship between smoking and chronic pain. Those who are in pain have a more difficult time in the cessation of smoking as well as an increased sensitivity to pain during abstinence, lower confidence, and higher relapse rates. The fear of pain and the anxiety and depression that abstinence causes results in a grim outcome for long-term cessation. The dependent nature between chronic pain and smoking is affected by numerous variables. Providers should consider a multiprong approach to treating chronic pain and targeting smoking cessation treatment by providing motivational therapy, nicotine replacement, and medication therapies to prevent relapse, and providing those who are more likely to relapse with a higher level of care.
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Affiliation(s)
- Christopher L Robinson
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
| | - Rosa S Kim
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Michael Li
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Qing Zhao Ruan
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Sindhuja Surapaneni
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Mark Jones
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Daniel J Pak
- Department of Anesthesia, Weill Cornell Medical College, New York, NY, USA
| | - Warren Southerland
- Department of Anesthesia, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Hammett PJ, Businelle MS, Taylor BC, Erbes CR, Bastian L, Doran N, Sherman SE, Rogers ES, Burgess DJ, Fu SS. The Association Between Smoking Abstinence and Pain Trajectory Among Veterans Engaged in U.S. Department of Veterans Affairs Mental Health Care. PAIN MEDICINE 2021; 22:1793-1803. [PMID: 33502511 DOI: 10.1093/pm/pnab009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time. DESIGN A secondary analysis of the "Proactive Outreach for Smokers in VA Mental Health" study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care. METHODS Participants were categorized into "low" (n = 616), "moderate" (n = 479), and "severe" pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups. RESULTS There were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores. CONCLUSIONS In this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael S Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.,Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Christopher R Erbes
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota Medical School, Minnesota
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut.,School of Medicine, Yale University, New Haven, Connecticut
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, California.,Department of Psychiatry, University of California, San Diego, California
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Erin S Rogers
- VA New York Harbor Healthcare System, New York.,Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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4
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Croghan IT, Hurt RT, Ganesh R, Bhagra O, Fischer KM, Vincent A, Hays JT, Bierle DM, Schroeder DR, Fuehrer DL, Nanda S. The Association of Current Tobacco Status With Pain and Symptom Severity in Fibromyalgia Patients. Mayo Clin Proc Innov Qual Outcomes 2021; 5:614-624. [PMID: 34195553 PMCID: PMC8240153 DOI: 10.1016/j.mayocpiqo.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To describe current tobacco use among patients with newly confirmed fibromyalgia and evaluate the association between tobacco use status and severity of reported pain and other fibromyalgia symptoms. Patients and Methods Participants in this study were adult patients (N=1068) with fibromyalgia who met American College of Rheumatology 2010/2011 clinical criteria for fibromyalgia at the time of initial presentation to a Midwest fibromyalgia clinic (June 1, 2018, through May 31, 2019). Multiple linear regression analyses were performed to assess the association of tobacco use status with the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores. Covariates included in these analyses included age, sex, body mass index, depression, opioid medication use, and use of fibromyalgia-specific pharmacotherapy. Results The patients were largely women (87.0%; n=929), white (87.9%; n=939), and with an average ± SD age of 46.6±13.9 years. The WPI and SSS scores were significantly greater in current tobacco users compared with never tobacco users (WPI effect estimate [EE] = 1.03; 95% CI, 0.30 to 1.76; type III P=.020; SSS EE = 0.47; 95% CI, 0.11 to 0.84; type III P=.036). The WPI score was negatively associated with age (EE = −0.02 per year; 95% CI, −0.03 to −0.001 per year; P=.037) and no use of opioid medication (EE = −1.08; 95% CI, −1.59 to −0.57; P<.001) while positively associated with higher body mass index (EE = 0.03 per 1 kg/m2; 95% CI, 0.001 to 0.06 per kg/m2; P=.04) and higher Patient Health Questionnaire-9 score (EE = 0.12; 95% CI, 0.08 to 0.16; P<.001). Conclusion The results of our study suggest that tobacco use is associated with greater pain and other symptom severity in patients with fibromyalgia. These findings have important clinical and research implications for patients with fibromyalgia who use tobacco and who may benefit from early identification and timely implementation of tobacco cessation treatment to decrease pain and improve overall quality of life.
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Affiliation(s)
- Ivana T Croghan
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ryan T Hurt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ravindra Ganesh
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ojas Bhagra
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ann Vincent
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - J Taylor Hays
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Dennis M Bierle
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Debbie L Fuehrer
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Sanjeev Nanda
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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5
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Gold AK, Otto MW, Hoyt DL, Garey L, Smit T, Zvolensky M. Do Pain-Related Anxiety and Difficulties With Emotion Regulation Impact Abstinence Expectancies or Motivation to Quit E-Cigarette Use? J Stud Alcohol Drugs 2021; 82:414-421. [PMID: 34100710 PMCID: PMC8328231 DOI: 10.15288/jsad.2021.82.414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/15/2020] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Pain-related anxiety is a psychologically based construct that is associated with tobacco dependence and may have important relevance to e-cigarette use. Difficulties with emotion regulation, a relevant construct in motives for cigarette smoking, may interact with pain-related anxiety to yield worsened clinical outcomes among e-cigarette users. We evaluated whether pain-related anxiety and difficulties with emotion regulation independently and in interaction predict e-cigarette users' expectancies surrounding abstinence and their motivation to stop using e-cigarettes. METHOD Daily e-cigarette users (n = 290, mean age= 35.5, SD = 10.9, 56.6% male) completed an online survey about e-cigarette use. We conducted hierarchical multiple regression analyses to evaluate the main and interactive influence of pain-related anxiety and difficulties with emotion regulation on our outcomes. RESULTS Increased pain-related anxiety independently predicted negative abstinence expectancies and increased motivation to quit e-cigarette use (ps < .001). Increased difficulties with emotion regulation predicted only negative abstinence expectancies (ps < .01) when pain-related anxiety was included in the model. The interaction between pain-related anxiety and difficulties with emotion regulation was not significant. CONCLUSIONS As hypothesized, increased pain-related anxiety was associated with both negative expectancies of abstinence and increased motivation to quit e-cigarette use, but contrary to our hypothesis, difficulties with emotion regulation were not significantly associated with increased motivation to quit e-cigarette use when evaluated with pain-related anxiety in the model. These findings may elucidate processes influencing abstinence expectancies and motivation to quit in a sample of e-cigarette users, although replication in a larger, more diverse sample is warranted.
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Affiliation(s)
- Alexandra K. Gold
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Danielle L. Hoyt
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas
| | - Michael Zvolensky
- Department of Psychology, University of Houston, Houston, Texas
- University of Texas MD Anderson Cancer Center, Houston, Texas
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6
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Christian ZK, Youssef CA, Aoun SG, Afuwape O, Barrie U, Johnson ZD, El Ahmadieh TY, Hall K, Peinado Reyes V, Wingfield SA, Bagley CA. Smoking has a dose-dependent effect on the incidence of preoperative opioid consumption in female geriatric patients with spine disease. J Clin Neurosci 2020; 81:173-177. [PMID: 33222910 DOI: 10.1016/j.jocn.2020.09.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Tobacco use and narcotic medication have been associated with worse functional outcomes after surgery. Our goal was to investigate potential associations between smoking and preoperative opioid consumption in a geriatric population undergoing spine surgery, and their impact on postoperative outcomes. The records of 536 consecutive patients aged more than 65 years who underwent elective spinal surgery between November 2014 and August 2017 at a single institution were reviewed. Primary outcomes included rates of preoperative opioid consumption and postoperative hospital length of stay and complications. Males were more likely to be smokers than females (p < 0.001), whereas females were more likely to take opioid analgesics preoperatively (p = 0.022). Women with a history of smoking were more likely to have increased preoperative opioid consumption compared to those with no history of smoking (63.64% vs. 42.04%; p < 0.001). Such a relationship was not found in men. Subgroups analysis of female patients with a history of tobacco use comparing current and former smoker status showed that both groups exhibited increased preoperative opioid consumption compared to patients who never smoked (88.89% vs 42.04%; p < 0.001 for current users; 59.42% vs 42.04% for former users; p = 0.008). There was also a dose-depended relationship between smoking and increased preoperative opioid consumption. Geriatric female spine patients with a history of smoking have a higher incidence of preoperative opioid consumption. Opioid intake appears to increase with the number of pack-years, both in patients with a history of smoking and in those who currently smoke.
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Affiliation(s)
- Zachary K Christian
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Carl A Youssef
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Salah G Aoun
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States.
| | - Olusoji Afuwape
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Umaru Barrie
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Zachary D Johnson
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Tarek Y El Ahmadieh
- UT Southwestern Medical Center, Department of Neurological Surgery, United States
| | - Kristen Hall
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Valery Peinado Reyes
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Spine Center, United States
| | - Sarah A Wingfield
- UT Southwestern Medical Center, Department of Internal Medicine, Division of Geriatric Medicine, United States
| | - Carlos A Bagley
- UT Southwestern Medical Center, Department of Neurological Surgery, United States; UT Southwestern Medical Center, Department of Orthopedic Surgery, United States; UT Southwestern Spine Center, United States
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7
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Parkerson HA, Sareen J, Asmundson GJG. Breaking the cycle of smoking and pain: do pain-related anxiety and pain reduction expectancies sabotage attempts to quit smoking and can smoking cessation improve pain and pain-related disability outcomes? Cogn Behav Ther 2020; 50:154-171. [PMID: 32852241 DOI: 10.1080/16506073.2020.1798498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Contemporary models of smoking and pain suggest a reciprocal and self-perpetuating cycle, wherein smoking reduces pain in the short term but indirectly exacerbates pain in the long term. In a sample of participants engaged in an active smoking-cessation attempt, this investigation assessed a) whether specific smoking risk factors (i.e., smoking expectancies for pain reduction, pain-related anxiety) acted as barriers to cessation, and b) whether breaking the smoking-pain cycle through successful smoking abstinence impacted pain and pain-related disability outcomes for participants with pain. Participants comprised 168 smokers (44.4% with pain) who engaged in an online smoking-cessation program. Pain-related anxiety, but not smoking expectancies, accounted for a significant proportion of variance of smoking dependence from pre- to post-intervention. Results suggest that pain-related anxiety is a risk factor for maintained smoking dependence for all smokers regardless of pain status. Participants with pain who successfully quit smoking experienced statistically and clinically meaningful decreases in pain and pain-related disability from pre- to post-intervention. Exploratory post hoc analyses indicated that individuals who signed-up for the smoking cessation program but failed to begin a quit-attempt had significantly higher pain disability, depression, and anxiety scores than participants who commenced a quit-attempt. Theoretical and practical implications are discussed.
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Affiliation(s)
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba , Winnipeg, Canada
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8
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Affiliation(s)
- Lisa R. LaRowe
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
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9
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Weinberger AH, Seng EK, Ditre JW, Willoughby M, Shuter J. Perceived Interrelations of Pain and Cigarette Smoking in a Sample of Adult Smokers Living With HIV/AIDS. Nicotine Tob Res 2020; 21:489-496. [PMID: 29394402 DOI: 10.1093/ntr/nty021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/25/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigarette smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. This study examined the factor structure, reliability, and validity of a measure of perceived interrelations of pain and smoking in a sample of PLWH. METHODS Participants in this study were 108 current cigarette smoking PLWH (64.8% reporting current pain) in the Bronx, NY. Participants completed assessments of demographics, smoking behaviors, and pain. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI). The dimensionality of the PSI was evaluated using Horn's Parallel Analysis and exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha, and validity analyses evaluated the relationship between the PSI and demographics, HIV clinical characteristics, smoking, and pain in the total sample. RESULTS A single-factor structure was the best fit for the PSI. The internal consistency of the PSI total score was excellent in the total sample (α = 0.94) and among participants with pain (α = 0.93). The PSI total score was significantly higher for PLWH who smoke and had current pain versus no current pain. Among smokers with HIV and pain, higher PSI scores were associated with higher pain interference, pain severity, and certain neuropathic pain symptoms (ie, numbness and pain to touch). CONCLUSIONS Among a sample of PLWH, the PSI appeared to be a reliable and valid instrument as a one-factor measure to assess perceived interrelations among pain and cigarette smoking. IMPLICATIONS Even though PLWH have very high prevalences of both pain and cigarette smoking, little is known about the relationship between pain and smoking for PLWH. This study is the first to examine a measure of the perceived interrelations of pain and smoking in a sample of PLWH. The measure was reliable and valid, and higher scores, reflecting that higher perceived interrelations of pain and smoking, were associated with more intense pain and pain interference. Learning more about pain and smoking among PLWH will help to better target smoking interventions to this key subgroup of smokers.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY
| | | | - Jonathan Shuter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
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10
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Bello MS, McBeth JF, Ditre JW, Kirkpatrick MG, Ray LA, Dunn KE, Leventhal AM. Pain as a predictor and consequence of tobacco abstinence effects amongst African American smokers. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 127:683-694. [PMID: 30070540 PMCID: PMC7473762 DOI: 10.1037/abn0000367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
African Americans are subject to health disparities in smoking and chronic pain. Given that nicotine has analgesic properties, increases in acute pain may be an expression of the tobacco abstinence syndrome, particularly among African American smokers with chronic pain. This report is a secondary analysis of data from an ongoing study of individual differences in laboratory-derived tobacco abstinence phenotypes in African American smokers. We tested whether overnight smoking abstinence increased acute pain and whether abstinence-induced changes in acute pain were correlated with other expressions of tobacco abstinence and amplified among smokers with chronic pain. African American smokers (N = 214; 10+ cig/day) attended a baseline visit (when chronic pain was reported), and two counterbalanced experimental sessions (ad libitum smoking vs. 16-hr smoking abstinence). At both experimental sessions, measures of self-reported acute pain and other tobacco abstinence symptoms were administered. Smoking abstinence significantly increased acute pain (d = .17, p = .01). Correlations between abstinence-induced changes in acute pain and abstinence-induced changes in negative affect, r = .15, p = .02, smoking urges, r = .13, p = .05, and composite nicotine withdrawal symptoms, r = .13, p = .06, were small and nonsignificant after correction for multiple tests, indicating that phenotypic variation in abstinence-provoked changes in acute pain and other tobacco abstinence expressions were largely independent. Baseline levels of chronic pain predicted greater abstinence-induced pain amplification at experimental sessions (βs = .29-.31; ps < .001). Acute pain is greater following overnight tobacco abstinence (vs. satiation) among African American smokers, predominantly among those with chronic pain. Addressing pain in tobacco addiction science, treatment, and health equity programming warrants consideration. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Mariel S Bello
- Department of Psychology, University of Southern California
| | | | | | | | - Lara A Ray
- Department of Psychology, University of California
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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11
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Siletz A, Childers CP, Faltermeier C, Singer ES, Hu QL, Ko CY, Kates SL, Maggard-Gibbons M, Wick E. Surgical Technical Evidence Review of Hip Fracture Surgery Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151459318769215. [PMID: 29844947 PMCID: PMC5964861 DOI: 10.1177/2151459318769215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 01/04/2023] Open
Abstract
Background: Enhanced recovery pathways (ERPs) have been shown to improve patient outcomes in a variety of contexts. This review summarizes the evidence and defines a protocol for perioperative care of patients with hip fracture and was conducted for the Agency for Healthcare Research and Quality safety program for improving surgical care and recovery. Study Design: Perioperative care was divided into components or “bins.” For each bin, a semisystematic review of the literature was conducted using MEDLINE with priority given to systematic reviews, meta-analyses, and randomized controlled trials. Observational studies were included when higher levels of evidence were not available. Existing guidelines for perioperative care were also incorporated. For convenience, the components of care that are under the auspices of anesthesia providers will be reported separately. Recommendations for an evidence-based protocol were synthesized based on review of this evidence. Results: Eleven bins were identified. Preoperative risk factor bins included nutrition, diabetes mellitus, tobacco use, and anemia. Perioperative management bins included thromboprophylaxis, timing of surgery, fluid management, drain placement, early mobilization, early alimentation, and discharge criteria/planning. Conclusions: This review provides the evidence basis for an ERP for perioperative care of patients with hip fracture.
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Affiliation(s)
- Anaar Siletz
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher P Childers
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Claire Faltermeier
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Emily S Singer
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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12
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Oh TK, Kim K, Jheon S, Do SH, Hwang JW, Kim JH, Jeon YT, Song IA. Relationship between pain outcomes and smoking history following video-assisted thoracic surgery for lobectomy: a retrospective study. J Pain Res 2018; 11:667-673. [PMID: 29670393 PMCID: PMC5896682 DOI: 10.2147/jpr.s157957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The relationship between chronic smoking history and postoperative pain remains controversial. This study aimed to elucidate this relationship in non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) lobectomy. Patients and methods This retrospective observational study included NSCLC patients treated with VATS lobectomy between January 2011 and July 2017. Demographic and clinical information, including preoperative smoking history, was collected. The primary goal was to investigate the relationship between smoking history and postoperative pain outcomes (oral morphine equivalent [OME] consumption and pain score). Multivariate linear regression analysis was performed, and P<0.05 was considered as statistically significant. Results A total of 1,785 patients were included in the final analysis. Multivariate linear regression analysis revealed that total smoking amount (in packs), status as current smoker, and cessation time did not have an association with OME consumption (mg) or pain scores on postoperative days 0–2 (P>0.05). However, patients who had never smoked consumed less morphine equivalent analgesics (mg) on postoperative days 0–2 (coefficient: −17.48, 95% CI [−33.83, −1.13], P=0.036) compared to patients who had a history of smoking. Conclusion Patients who had never smoked had lower opioid analgesics consumption on the days immediately following surgery, while being a current smoker or the total amount of smoking in packs did not affect postoperative pain outcomes after VATS lung lobectomy.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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13
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Childers CP, Siletz AE, Singer ES, Faltermeier C, Hu QL, Ko CY, Golladay GJ, Kates SL, Wick EC, Maggard-Gibbons M. Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151458518754451. [PMID: 29468091 PMCID: PMC5813847 DOI: 10.1177/2151458518754451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/30/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.
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Affiliation(s)
| | - Anaar E Siletz
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emily S Singer
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA
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14
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Schönbach EM, Ibrahim MA, Kong X, Strauss RW, Muñoz B, Birch DG, Sunness JS, West SK, Scholl HPN. Metrics and Acquisition Modes for Fixation Stability as a Visual Function Biomarker. Invest Ophthalmol Vis Sci 2017; 58:BIO268-BIO276. [PMID: 28973313 PMCID: PMC6733530 DOI: 10.1167/iovs.17-21710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare different metrics and acquisition modes of fixation stability as a new visual function biomarker in a large cohort of patients with ABCA4-related Stargardt disease from the multicenter prospective ProgStar study. Methods Fixation was tested during a separate fixation exam and also dynamically during a sensitivity exam, using fundus-tracking microperimetry (Nidek MP-1). Fixation data were analyzed using the bivariate contour ellipse area (BCEA), the 2/4 degree method, and the Fujii classification. Results In a total of 235 patients, the mean BCEA was larger when measured during the sensitivity exam (418 eyes; 12.5 vs. 4.6 deg2 during the fixation task in 427 eyes). Correlations between the two tests were generally weak. Fixation stability during the sensitivity test was significantly correlated with visual acuity. Comparing the BCEA values and the corresponding Fujii categories for these eyes revealed ranges of overlap where an eye with one defined BCEA value can fall into each of the three Fujii categories. Conclusions Patients may have limited ability to fixate over defined time periods, which leads to significant differences between shorter and longer measurements of fixation stability. The most appropriate way to use this functional biomarker appears to be using continuous metrics for fixation stability, such as the BCEA, during a macular sensitivity test.
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Affiliation(s)
- Etienne M Schönbach
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Mohamed A Ibrahim
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Biostatistics and Epidemiology, University of Massachusetts-Amherst, Amherst, Massachusetts, United States
| | - Rupert W Strauss
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Moorfields Eye Hospital, London, United Kingdom.,Department of Ophthalmology, Johannes Kepler University, Linz, Austria.,Department of Ophthalmology, Medical University, Graz, Austria.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Beatriz Muñoz
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - David G Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Janet S Sunness
- Hoover Low Vision Rehabilitation Services, Greater Baltimore Medical Center, Baltimore, Maryland, United States
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Hendrik P N Scholl
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Ophthalmology, University of Basel, Basel, Switzerland
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15
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Behrend CJ, Schönbach EM, Vaccaro AR, Coyne E, Prasarn ML, Rechtine GR. Maximum pain on visual analog scales in spinal disorders. Spine J 2017; 17:1061-1065. [PMID: 27939747 DOI: 10.1016/j.spinee.2016.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/28/2016] [Accepted: 11/28/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Determining pain intensity is largely dependent on the patient's report. PURPOSE The objective of this study was to test the hypothesis that patients initially reporting a pain score of 10 out of 10 on the visual analog scale (VAS) would experience symptom improvement to a degree similar to patients reporting milder pain. STUDY DESIGN This study is a retrospective chart review. PATIENT SAMPLE A total of 6,779 patients seeking care for spinal disorders were included in the study. OUTCOME MEASURES The outcome measures used in the study were pain scores on the VAS pain scale, smoking status, morbid depression, gender, and the presence of known secondary gain. MATERIALS AND METHODS Patients with lumbar degenerative disk disease with or without spinal stenosis who reported a VAS pain score of 10 out of 10 were identified. Changes in reported VAS pain, patient age, smoking status, morbid depression, gender, and the presence of known secondary gain were examined. RESULTS A total of 160 individuals (2.9%) reported a maximum pain score of 10 out of 10 on a VAS at their initial presentation. The patients had a median improvement of 3 points in reported VAS pain between the first visit and the last follow-up appointment. The odds to improve by at least 40% on the VAS were 1.500 (95% confidence interval 1.090-2.065) compared with patients reporting submaximal pain. The proportion of patients with identifiable secondary gain was higher (p=.001) than that of patients with submaximal pain. Patients whose pain scores improved dramatically (ie, at least 4 points on the VAS) tended to be older (p=.001), to less often have secondary gain from their disease (p=.007), and to have a negative current smoking status (p=.002). Patients whose pain remained 10 out of 10 during the course of treatment smoked more frequently (p=.016). CONCLUSIONS Our analysis supports the need to consider the influence of secondary gain on the patients' reported VAS pain scores. Maximum pain seems to be a more acute phenomenon with some likelihood to significantly improve.
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Affiliation(s)
- Caleb J Behrend
- Carilion Clinic Orthopaedics, Virginia Tech, 2331 Franklin Rd, Roanoke, VA 24014, USA
| | - Etienne M Schönbach
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA.
| | - Alexander R Vaccaro
- Rothman Institute, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107, USA
| | - Ellen Coyne
- Independent Statistical Support, Rochester, NY, USA
| | - Mark L Prasarn
- Department of Orthopaedics and Rehabilitation, University of Texas, 6431 Fannin St, Houston, TX 77030, USA
| | - Glenn R Rechtine
- Department of Orthopaedics, Veterans Affairs Medical Center, 1100 Tunnel Rd, Asheville, NC 28805, USA
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16
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Vasquez RA, Chotai S, Wick JB, Stonko DP, Cheng JS, Bydon M, Asher AL, McGirt MJ, Devin CJ. The Profile of a Smoker and Its Impact on Outcomes After Cervical Spine Surgery. Neurosurgery 2016; 63 Suppl 1:96-101. [PMID: 27399373 DOI: 10.1227/neu.0000000000001284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Raul A Vasquez
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky
| | - Silky Chotai
- Department of Orthopedic and Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Joseph B Wick
- Department of Orthopedic and Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - David P Stonko
- Department of Orthopedic and Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Joseph S Cheng
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Matthew J McGirt
- Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopedic and Neurological Surgery, Vanderbilt University, Nashville, Tennessee
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