Does Smoking Cause Low Back Pain?

According to the Centers for Disease Control and Prevention (CDC), an estimated 14% of Americans are current smokers, and therefore at risk for a number of smoking-related conditions. Low back pain is one such condition that has a strong association with smoking.

Specific findings in research show:

The more frequently one smokes, the greater the risk of back pain¹
Smokers with low back pain also tend to have pain in the leg, usually extending below the knee²

Smoking may change the level of nutrients, such as cholesterol and vitamins, in the blood and the health of organs, such as the heart and the lungs. While these metabolic changes may help explain the link between smoking and a degenerating spine, it remains to be seen if smoking is a cause of back pain.

Smoking Alters Blood Flow and May Lead to Back Pain

Consequences of smoking may indirectly contribute to the development of degenerative lumbar spine problems. These consequences include, but are not limited to¹^,³^-⁵:

Hypertension, or high blood pressure. A history of cigarette smoking impairs the ability of the endothelium (the thin membrane of cells lining the blood vessels) to regulate blood pressure, causing hypertension (elevated blood pressure) in some individuals.
Abnormally high blood cholesterol. High levels of cholesterol, also known as hyperlipidemia, can go undetected but increase the risk of developing coronary artery disease.
Atherosclerosis, or narrowing of the arteries. Atherosclerosis is aggravated by hypertension and abnormal cholesterol levels.

Atherosclerosis causes decreased blood flow to organs and tissues and may result in ischemia. Atherosclerosis in the aorta (a main artery of the heart) and ischemia in the leg have long been considered potential causes of low back pain and intervertebral disc degeneration.⁶^-⁸

Passive smoking,⁹ also called second-hand smoking, and waterpipe tobacco smoking,¹⁰^,¹¹ commonly known as hookah, similarly contribute to abnormal blood pressure and cholesterol. The combination of cigarette smoking and waterpipe smoking may increase cholesterol levels higher than either type of smoking alone.¹²

Smoking Weakens the Spine’s Health

Smoking reduces the nutrient content of the blood that is delivered to the intervertebral discs and joints of the spine. Studies have drawn conclusions about whether or not the following effects of smoking play a role in back pain:

Low vitamin D. Smoking alters the speed of vitamin D production,¹³ the amount of vitamin D circulating in the blood,¹⁴ and the number of vitamin D receptors.¹⁵ Gradually, these effects may lead to vitamin D deficiency. Moderate deficiency of vitamin D has the potential to decrease bone density, which may contribute to the development of bone fractures.¹⁶ The association between vitamin D deficiency and low back pain is well-established,¹⁷ but may only exist for certain subgroups such as women less than 60 years old¹⁸ or individuals with severe vitamin D deficiency.¹⁹
Low vitamin C. Smokers generally metabolize vitamin C faster and have lower vitamin C levels in the blood as a result of the rapid metabolism.²⁰ While vitamin C has been a factor of interest in low back pain research, vitamin C deficiency does not explain the link between smoking and back pain.

More research is needed to explore the possible ways that smoking leads to prolonged and more frequent episodes of back pain. Targeted treatments, such as vitamin C supplements, can be tailored to current or former smokers with back pain or at risk of developing back pain, once the association is better understood.

Smoking Promotes the Development of Chronic Back Pain

Smoking also has certain effects on brain circuitry. Back pain is more likely to become chronic in smokers, possibly due to the cooperation of specific areas of the brain— the nucleus accumbens and the medial prefrontal cortex.²¹ These regions of the brain are known for their role in many cognitive functions, such as reward, addiction, and habit formation. The connection between these brain regions weakens after quitting smoking.

Back Pain After Quitting Smoking

The habit of smoking is an important obstacle to overcome, and one way that smoking cessation may pay off is with a reduced risk of back pain.

Former daily smokers may experience generalized body pain, including back pain, that continues or begins after smoking cessation.²² After quitting, nicotine withdrawal causes the level of serotonin in the brain to decrease. With lower serotonin levels, the sensitivity to pain increases.²³ Smokers with chronic pain may be advised to quit smoking gradually or to alleviate withdrawal symptoms using nicotine patches.

The neurological and vascular effects of smoking on the back can be reduced by quitting, but cannot be fully reversed. Both current and former smokers are at risk for numerous conditions, including low back pain and degenerative disc disease, because of the lingering effects of smoking.

See When to Quit Smoking

Smoking and Low Back Pain Among Certain Groups

Factors such as age, gender, and history of spinal conditions may turn the dial up on the influence that smoking has on the spine. Research studies of hundreds of individuals have supported the following findings:

Adolescents who smoke were up to 2.4 times as likely to experience low back pain compared to nonsmoking adolescents.²⁴
Adult smokers were about 30% more likely to have low back pain compared to nonsmoking adults.²⁵
Men who smoke were 18% more likely to have low back pain, 25% more likely to have disc degeneration, 33% more likely to have spinal instability, 49% more likely to have spondylolisthesis, and 52% more likely to have spinal stenosis compared to nonsmoking men.²⁶
Women who smoke were 50% more likely to experience chronic back pain compared to women who never smoked.²⁷
Smokers with a history of adolescent idiopathic scoliosis are more likely to have back pain than smokers without the condition.²⁸

Both back pain and associated leg pain are less common in former smokers than in current smokers,¹¹ so quitting smoking may alleviate back pain and may also improve outcomes after back surgery.²⁹

See Ways to Quit Smoking