Using a prospectively maintained database, Caleb Behrend, M.D., from the University of Rochester in New York, and colleagues examined the records for 5,333 patients with axial or radicular pain from a spinal disorder. The authors examined the effect of smoking history on the patient assessment of pain on four visual analog scales during the course of care.The researchers found that patients who were current smokers reported significantly greater pain in all visual analog scale pain ratings, compared to patients who had never smoked. There were significant differences in the mean improvement in reported pain over the course of care between nonsmokers and current smokers. Those who had quit smoking during the course of care reported significantly greater improvement in pain in visual analog scale pain ratings for worst, current, and average weekly pain, compared to those who continued to smoke. There was clinical importance to the mean improvement in the visual analog scale pain ratings in all three groups of nonsmokers (never smokers, quit prior to study, quit during the course of care), while those who continued smoking during care did not experience a clinically significant improvement in reported pain.