Smoking is associated with greater pain intensity and pain-related occupational disability in Japanese workers

  • Keiko YamadaEmail author
  • Kenta Wakaizumi
  • Yasuhiko Kubota
  • Ko Matsudaira
  • Masahiko Shibata
Original Article



Pain symptom, such as that caused by musculoskeletal disorders, is a major cause of occupational disability. As nicotine intake from smoking increases pain sensitivity, smokers may experience stronger pain and be more likely to experience pain-related disability than non-smokers. The study aim was to examine whether smoking was associated with pain-related occupational disability via pain intensity.


Participants were 1189 workers with pain aged 20–74 years in Japan. Participants completed a self-report questionnaire, which included a question to measure pain-related occupational disability with ordinal-option: (1) without pain-related disability, (2) pain-related presenteeism, and (3) pain-related absenteeism. An ordinal logistic regression model was used to calculate multivariable-adjusted proportional odds ratios (OR) with 95% confidence intervals (CI) for the prevalence of pain-related occupational disability according to smoking status. A multiple mediation analysis was also conducted to assess whether pain sensitivity mediated the association between smoking and pain-related occupational disability. Adjusted variables were demographic variables, socioeconomic status, work-related psychosocial factors, general psychological factors, and pain duration.


Current smoking and pain were associated with pain-related occupational disability compared with non-smoking and pain (multivariable OR 1.78; 95% CI 1.26–2.52). Greater pain intensity partially mediated the association of current smoking and pain with pain-related occupational disability. The mediation rate (indirect/total effect) was 25%.


Smoking and pain were associated with pain-related occupational disability, partially through greater pain intensity, among Japanese workers.


Smoking Disability studies Occupational medicine Pain Pain measurement 



We are grateful to all the participants from the three companies. We thank Dr. Kyosuke Fukai, Dr. Yuichiro Kawatsu, Dr. Azusa Shima, and other staffs from the three companies for their support in conducting this survey. We thank Diane Williams, Ph.D., from Edanz Group ( for editing a draft of this manuscript.


This research was supported by a grant for The Research Project on Elucidation of Chronic Pain from the Japan Agency for Medical Research and Development, AMED (16EK0610004H0003), Health Labour Sciences Research Grants, and Industrial Disease Clinical Research Grants (14020301-01). This research was supported in part by a fellowship to Keiko Yamada from the Astellas Foundation for Research on Metabolic Disorders and supported in part by a research assistantship of a Grant-in-Aid to Kenta Wakaizumi and the Program for Leading Graduate School for “Science for Development of Super Mature Society” from the Ministry of Education, Culture, Sport, Science, and Technology in Japan.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

540_2019_2661_MOESM1_ESM.pdf (283 kb)
Supplementary material 1 Online Resource 1 Supplementary Table 1. Variable mean values and proportions (PDF 283 kb)


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Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Public Health, Department of Social MedicineOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Anesthesiology and Pain MedicineJuntendo University Faculty of MedicineTokyoJapan
  3. 3.Department of PsychologyMcGill UniversityMontrealCanada
  4. 4.Shirley Ryan AbilityLabChicagoUSA
  5. 5.Department of Physical Medicine and Rehabilitation, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  6. 6.Osaka Center for Cancer and Cardiovascular Diseases PreventionOsakaJapan
  7. 7.Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of MedicineThe University of TokyoTokyoJapan
  8. 8.Department of Health ScienceNaragakuen UniversityNaraJapan

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