Can Quitting Smoking Help Relieve Back Pain?

Can quitting smoking help relieve back pain? It seems there aren't enough reasons to quit smoking, but chronic back pain sufferers—and those who want to avoid chronic back pain (who wouldn't?)—may have another reason. Research to date suggests that smoking is associated with an increased incidence of chronic pain, particularly back pain.
 
The exact reasons are still being explored, and research has not proven that smoking causes chronic back pain. However, while it is unethical to conduct randomized controlled trials requiring some participants to smoke to study the effects on back pain, observational data comparing smokers and non-smokers provide substantial support for the relationship between smoking and chronic pain.

Dr. Crawford Barnett, a pain management expert at Cleveland Clinic Hillcrest Hospital, states that the evidence is strong enough that "I think we can, with a fair degree of certainty, link smoking to multiple negative outcomes related to back pain." Research has found that smoking is associated with increased risks of osteoporosis, lumbar disc disease (or diseases affecting the lower back), and bone healing issues. Studies show that smokers who suffer from spinal injuries or other back problems, which may be short-term for some, are more likely to develop chronic pain.

It is certain that nicotine in cigarettes can provide short-term pain relief, complicating the efforts of those with chronic pain to quit smoking. However, in addition to the countless health issues caused by smoking and the increased risk of life-threatening diseases from lung cancer to heart disease, the net effect of nicotine also seems to be harmful to the back. Barnett explains: "The problem is that you quickly develop a tolerance to it. You need more and more of the drug to achieve the same effect, and eventually, you get no effect at all, even though your body craves this chemical because it has become accustomed to it physiologically."

Therefore, while smokers may feel temporary relief from pain when lighting a cigarette, nicotine also has similar effects on them in other ways. Barnett states: "Nicotine itself is a vasoconstrictor, which means it narrows blood vessels. So if I expose any blood vessels in my body to nicotine, they will constrict, reducing the oxygen they receive. For pain, if (I) have a bad back, I need extra blood flow to help with healing... I am reducing that. Those automatic areas—just by the structure of things—receive little blood flow, like the lumbar discs, which can reduce even more."

A study of 331,941 Swedish construction workers found that smokers were more likely to undergo surgery for lumbar stenosis. While lumbar stenosis typically results from normal wear and tear as one ages, smoking has been linked to increased degeneration of intervertebral discs. A 2018 study published in the journal Spine also found a "dose-dependent" relationship, indicating that heavy smokers or those who smoke 15 or more cigarettes a day are at a higher risk of needing surgery for lumbar stenosis compared to moderate smokers (those who smoke 1 to 14 cigarettes a day) or former smokers.

More importantly, smoking brings a double whammy. This is because research has also shown that for patients undergoing surgery, whether using implanted devices like nerve stimulators to block pain or undergoing spinal surgery, smoking is associated with poorer treatment outcomes and higher risks. Barnett states: "If patients continue to smoke, many surgeons will not perform elective spinal surgery."

He explains that, in addition to increasing the risk of complications during surgery, smoking also impairs the body's ability to recover. Barnett explains: "When you heal, you need oxygenated blood, and if that is restricted, you won't heal. You want your wounds to heal, you want everything to solidify, you don't want your wounds to rupture, and you don't want bone grafts to fail. Therefore, it has a huge impact on the final outcomes for patients."

Another study indicates that smoking affects a person's pain on a brain or nervous system level.

A 2014 study published in the journal Human Brain Imaging focused on the connection between smoking, chronic pain, and brain physiology, specifically the transition from so-called subacute pain (or back pain lasting 4 to 12 weeks) to chronic pain. In particular, it focused on areas of the brain known as the nucleus accumbens and the medial prefrontal cortex (mpfc). The lead author of the study, Bogdan Petre, a graduate student in psychology and neuroscience at the University of Colorado Boulder, states: "It seems that there is some emotional component in the information shared between the accumbens and the PFC that captures pain." Petre, who leads this research at Northwestern University, adds: "We also found that during our study, a small portion of participants quit smoking, and this segment showed a dramatic decrease in the information shared."
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It is through specific types of brain activity and connectivity visible via brain imaging that seems to be associated with an increased risk of transitioning to chronic pain due to smoking. "We cannot claim causation here, but it seems there is a close connection between their smoking, the known circuits associated with addictive behavior, and the rate of pain persistence one year later," Petre states.

Experts say that, in general, more research is needed to understand exactly why smoking leads to chronic pain. However, clinicians say that since there are countless reasons to quit this habit, this is another reason that should not be overlooked. As part of a comprehensive approach to reducing or preventing persistent back pain, patients should discuss this issue with their healthcare providers.