Can Quitting Smoking Help Relieve Back Pain?

Can quitting smoking help relieve back pain? It seems there isn't enough reason for chronic back pain sufferers—and those who want to avoid chronic back pain (who wouldn't?)—to quit smoking, but there may be 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 where some participants are asked to smoke to study the effects on back pain, observational data comparing smokers and non-smokers provides substantial support for the relationship between smoking and chronic pain.

Dr. Crawford Barnett, a pain management expert at Cleveland Clinic, 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." Studies have found that smoking is associated with increased risks of osteoporosis, lumbar disc disease (or diseases affecting the lower back), and bone healing problems. Research indicates that smokers are more likely to develop chronic pain if they suffer from spinal injuries or other back issues, which for some may be short-term problems.

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 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 have no effect at all, even though your body now craves this chemical because it has become physiologically accustomed to it."

Thus, while smokers may feel temporary relief from pain when lighting a cigarette, nicotine 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 heal... I am reducing that. Those automatic areas—just by the structure of things—get very 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 is associated with increased degeneration of intervertebral discs. A study published in 2018 in the journal Spine also found a "dose-dependent" relationship, meaning heavy smokers or those who smoke 15 or more cigarettes a day have 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, it is associated with poorer treatment outcomes and higher risks. Barnett states: "If patients are still smoking, many surgeons will not perform elective spinal surgery."

He explains that smoking increases the risk of complications during surgery, such as infections, and also impairs the body's ability to recover. Barnett explains: "Because when you heal, you need oxygenated blood, and if that is restricted, you won't heal. You want the wound to heal, you want everything to solidify, you don't want the wound to burst, and you don't want the bone graft to fail. Therefore, it has a huge impact on the final outcome for patients."

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

A study published in 2014 in the journal Human Brain Mapping focused on the connection between smoking, chronic pain, and brain physiology, specifically transitioning 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 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 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 during this phase, the information sharing dropped sharply."

It is through specific types of brain activity and connectivity visible through 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 some close connection between their smoking, the known circuits associated with addictive behavior, and the rate of pain persistence a year later," Petre states.

Experts say that generally, more research is needed to understand precisely 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.