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Prevalence of smoking in adults with spinal cord stimulators: a systematic review and meta-analysis
  1. W Michael Hooten1,
  2. Rajat N Moman1,
  3. Jodie Dvorkin2,
  4. E Morgan Pollard1,
  5. Robalee Wonderman1 and
  6. M Hassan Murad3
  1. 1 Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2 Institute for Clinical Systems Improvement, Bloomington, Minnesota, USA
  3. 3 Preventive Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr W Michael Hooten, Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA; hooten.william{at}


Background Smoking adversely impacts pain-related outcomes of spinal cord stimulation (SCS). However, the proportion of SCS patients at risk of worse outcomes is limited by an incomplete knowledge of smoking prevalence in this population. Thus, the primary aim of this systematic review is to determine the prevalence of smoking in adults with chronic pain treated with SCS.

Methods A comprehensive search of databases from 1 January 1980 to 3 January 2019 was conducted. Eligible study designs included (1) randomized trials; (2) prospective and retrospective cohort studies; and (3) cross-sectional studies. The risk of bias was assessed using a tool specifically developed for prevalence studies. A total of 1619 records were screened, 19 studies met inclusion criteria, and the total number of participants was 10 838.

Results Thirteen studies had low or moderate risk of bias, and six had a high risk of bias. All 19 studies reported smoking status and the pooled prevalence was 38% (95% CI 30% to 47%). The pooled prevalence in 6 studies of peripheral vascular diseases was 56% (95% CI 42% to 69%), the pooled prevalence of smoking in 11 studies of lumbar spine diagnoses was 28% (95% CI 20% to 36%) and the pooled prevalence in 2 studies of refractory angina was 44% (95% CI 31% to 58%).

Conclusions The estimated prevalence of smoking in SCS patients is 2.5 times greater than the general population. Future research should focus on development, testing and deployment of tailored smoking cessation treatments for SCS patients.

  • chronic pain: back pain
  • neuromodulation: spinal cord stimulation
  • pain medicine

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  • Presented at The study findings have not been previously presented at a scientific meeting.

  • Contributors WMH took part in design of this project, interpretation of data and writing the manuscript. RNM took part in design of this project, acquisition of data, analysis and interpretation of data, and writing the manuscript. JD, EMP and RW took part in acquisition of data. MHM took part in conception and design of this project, and analysis and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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