DÄ internationalArchive38/2008Smoking and Chronic Back Pain – Analyses of the German Telephone Health Survey 2003: In Reply


Smoking and Chronic Back Pain – Analyses of the German Telephone Health Survey 2003: In Reply

Dtsch Arztebl Int 2008; 105(38): 654. DOI: 10.3238/arztebl.2008.0654b

Zimmermann-Stenzel, M

LNSLNS To 1.) In my opinion, the bivariate results should be and were in fact regarded critically, as they do not include any control for third variables which might influence the risk of back pain. Indeed only the multivariate analyses provide information on factors, by controlling for additional variables. This is why the discussion of the results primarily concentrates on the mutlivariate results. Moreover, the generalization at the start of the discussion is not wrong and certainly not wrong in two respects, as there is generally a real association between smoking and back pain. Daily smokers and former smokers are more often affected than people who have never smoked and not all smokers are equally affected, as is explained in more detail in the following sentence and paragraph.

To 2.) The cross-sectional design does not permit the conclusion that smoking disturbs physical function in such a way that there is a greater risk of back pain. There is no question about this, as is stated in the third section of the discussion. Nevertheless, the cross-sectional data demonstrate that, within the group of smokers, there is a significant association between the occurrence of back pain and the duration of smoking of more than 16 years, and this is the most significant correlation with back pain.

To 3.) I agree that there was no problem in the use of a questionnaire or in the collection of data in a telephone interview. The problem was rather that the information on psychological health was not based on medical diagnoses. Moreover, the two items were based on two questions from the validated SF-36 questionnaire (http://www.sf-36.org/tools/SF36.shtml), an international, validated instrument for the measurement of physical and psychological health.
DOI: 10.3238/arztebl.2008.0654b

Dr. rer. soc. Monique Zimmermann-Stenzel
Stiftung Orthopädische Universitätsklinik Heidelberg
Schlierbacher Landstr. 200a
69118 Heidelberg, Germany

Conflict of interest statement
The authors of both the letter and of the reply declare that there is no conflict of interest in the sense of the guidelines of the International Committee of Medical Journal Editors.