Can Smoking Cause Back Pain?

'Smoking May Be Deadly, But Does It Actually Create Back Pain?'

The Short Answer –

Can smoking cause back pain? The short answer is Yes in the long term smoking can indeed cause back pain, but in the short term No it won’t.

Furthermore, smoking has been known to have certain analgesic effects that can actually reduce back pain in the short term.

We analyse further why it helps, why it hinders and where the crossover starts to happen giving you a clear answer to our readers question – can smoking cause back pain?

Establishing The Facts (Beyond The Smoke)

According to the National Institute Of Neurological Disorders And Stroke, nicotine (a major element of both cigarettes and vapes) increases the rate of degeneration by restricting blood flow to the discs that cushion the vertebrae in your spine.

It was also thought to hugely increase your chances of developing osteoporosis because it reduced your bodies natural calcium absorption (ultimately preventing new bone growth).

However, for many years this was largely unproven and even today many lazy commentators make the link between back pain and smoking without any comment on why/ how.

Smoking itself receives extremely negative press.

Much of this is justified of course – smoking kills many, many people before their time, but it can get blamed for absolutely everything.

Sometimes, while it’s overall effect may be overwhelmingly negative, it doesn’t actually cause what it’s being blamed for.

When it comes to back pain, the case is equally complex – and again at no point should it be considered that smoking is in any way, good for your health overall.

However, as a pain specialist, I still have a duty to disclose the truth, even when it is not always convenient with the wider picture.

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Can Smoking Cause Back Pain – The Short Term, The Inconvenient Truth (No!)

In simple terms, and in the short term at least, smoking does indeed have an analgesic effect on existing pain, including back pain.

In the long-term it may result in a much higher likelihood of developing back pain for a variety of reasons touched on further down – but in the short term it can actually be beneficial.

There is no evidence that smoking will create or cause back pain in the short term, and significant evidence that it may actually provide temporary relief from already established back pain.

But how? Well, nicotine is an agonist of what are known as ‘nicotinic acetylcholine receptors’ (nAChRs) found throughout the nervous system and the brain.

Without getting technical, the effect of nicotine on some of these nAChRs is to discharge epinephrine and catecholamines that inhibit the normal pain pathways (thus reducing your feelings of pain).

Similarly, as the nAChRs activate they also release other neurotransmitters including dopamine. This is part of the reason nicotine is so addictive, but also a major reason behind the sense of relaxation and pain relief that can be drawn from them.

For evidence of this we need only look at the study by Ditre et al in November 2011.
Del Arbol et al further built on this in their study adding knowledge that nicotine could stimulate beta-endorphins.

These have a very similar effect on your body to that of opioids such as morphine.

Shi et al (2010) added a 3rd short-term benefit to smoking that was modulation of pain reception in general – although this was found ineffective in chronic smokers, possibly due to a build-up of tolerance.

Finally, (and it’s not really a good point), but smoking has been known to increase blood pressure and increased blood pressure frequently results in a reduction in pain sensitivity.

In summary then, smoking’s short-term effect on back pain can be to –

  • Release epinephrine into the body, inhibiting normal pain pathways
  • Increase dopamine production
  • Release beta-endorphins (opioid polypeptide compounds) creating the effect of opioids
  • Initiates a ‘stress response’ that reduces pain perception.

Can Smoking Cause Back Pain – The Long-Term View (And New Clinical Data).

One of the biggest problems with testing smoking’s impact on back pain is that it is not immediately causal or obvious. It can take many years to see any impact whatsoever.

This makes any clinical trials very difficult, because people drop out or die over time, leading to poor results.

However, a few trials have now established a definitive link between smoking and long-term back pain, although this doesn’t mean by any stretch that you will too.

One particular study stands out that and confirms this was carried out by the John Hopkins University and reported in 2001. It actually managed to follow initial participants for up to 53 years after entering.

Furthermore it concluded that back pain was indeed linked directly to a history of smoking. In other words, across 1,337 patients, there was a higher incidence of back pain in those that did smoke, than those that didn’t.

The study concluded that those who smoked were significantly more likely to develop lumber spondylosis and thus suffer with back pain.

This was very significant because, spanning over 53years, it could actually show a clear cause and effect. Shorter-term studies tend to only show effect and then theorise around the potential cause.

This is further backed up by Peter F Ullrich of the NeuroSpine Center of Wisconsin who comments that

“…in fact smokers have a three hundred percent greater incidence of having chronic low back pain”

This so-called ‘fact’ most likely comes from a different trial, published in the peer-reviewed medical journal ‘Brain Mapping’ that observed just 68 people with ‘sub-acute back pain’.

It concluded that Smokers were three times more likely to develop chronic back pain.

It hit the headlines in 2014, when the Mail Online ran the headline

“Smokers are three times more likely to suffer from back pain”.

While much of what was reported was accurate, what it didn’t do was emphasize the point that it was a trial of just 68 patients and that the trial was actually about how smoking influenced people moving from sub-acute back pain to chronic back pain.

In other words, it set out to measure if smoking made existing back pain worse. It was not in fact about developing back pain from nothing.

Similarly, another claim in the same article, this time by the Mail Online that “quitting can ease symptoms” has no support from this study.

There are a number of other significant studies that do show a genuine causative link between consistent smoking and development of back pain. Not wishing to waste time, I have summarised these below.

However, this of course does not mean that everyone who smokes will develop back pain – just that your chances of doing so increase.

If you took 1000 people (for example) and 500 were smokers and 500 were non-smokers, then overall we’d expect maybe 200 smokers to develop chronic pain over the next 40 years and 150 of the non-smokers.

Although we could deduce that smoking does (all other things being equal), in some part cause back pain, it does not mean not if you smoke you will develop back pain.

Using those made-up figures, 300 smokers and 350 non-smokers will not develop back pain. In isolation, it Is quite possible to have two friends in which the non-smoker gets back pain and the smoker does not.

This is just statistical variance.

Other Conclusive Clinical Trials…

This gives many smokers a simple defence, but does not change the fact that numerous studies have defined a long-term link between back pain and smoking.

These include –

Ekholm et al (2009) 10,917 patients. They found that chronic pain was significantly higher in those individuals who regularly smoked cigarettes.

Alkherayf et al (2010). Looked at 73,507 people between 20 and 59yrs old. They reported a higher prevalence of lower back pain (23.3%) in daily smokers vs non-smokers (15.7%). They strongest relationship between lower back pain and smoking was actually in the younger group.

Mitchell et al (2011). 6,092 women over 18). They looked for evidence that smoking increased the likelihood of chronic pain. In the end, they observed a two-fold increase in smoking women compared to non-smoking women. ‘Some-day’ smokers also saw a 1.8-fold increase.

Petre et al (2014) – patients). Their study found a link between smoking and the number of people who’s back pain went from sub-acute to chronic.

Will Giving Up Smoking Save Me From Back Pain?

There are many great reasons to give up smoking – preventing an early death from stroke or cancer being one of the biggest.

However, if your smoking has contributed to you developing early stage osteoporosis of the spine for example (and that is what is causing your back pain), then giving up smoking will not reverse the effects.

What it may do though is help to slow your back pain’s progression.

But this may in turn be masked by losing the opioid and pain killing effect of the nicotine.

So if you give up, it is quite possible you will see a spike in pain as your body gradually breaks the addiction.

Unfortunately, increased pain sensitivity is to be expected.
But in the medium to long-term, it is likely you will greatly slow down the progression of your degenerating spine.

The Final Word –

Can Smoking cause back pain? In the long run, it has been proven to increase your chances of developing a range of spinal conditions that will lead to increased back, so yes.

However, in the short-term, smoking can not be linked to any increase in back pain – and actually has been proven to have numerous analgesic effects that would reduce pain.

Don’t be too overjoyed though – keep smoking and you will quite possible hasten the progression of your back pain to permanent and then to more severe.

Unfortunately, because it is the nicotine in cigarettes that both provides the boost and the reduction of blood flow to your spinal discs, the effect will be the same whether you smoke the traditional way or use vapes.

Whether you choose either method is a personal choice and not one I can comment on. If you know the upsides and the downsides, then it is your choice from here.

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References –

1. TheNational Instituate of Neurolgical Disorders and Stroke.
2. Joseph W. Ditre, Thomas H. Brandon, Emily L. Zale and Mary M. Meagher. (Nov 2011). Pain, Nicotine, and Smoking: Research Findings and Mechanistic Considerations. Psychological Bulletin.
3. J.L. del Arbola, J. Raya MunÄoza , L. Ojedaa , A. LoÂpez Cascalesa , J. Rico Irlesa , M.T. Mirandab , M.E. Ruiz Requenac , J.C. Aguirrea. (March 2000). Plasma concentrations of beta-endorphin in smokers who consume different numbers of cigarettes per day. Pharmocology Biochemistry and Behavior.
4. Yu Shi M.D, M.P.H. Toby N. Weingarten M.D, Carlos B. Mantilla M.D, Ph.D; W. Michael Hooten M.D.; David O. Warner, M.D. (October 2010). Smoking and Pain: Pathophysiology and Clinical Implications. Anesthesiology.
5. Ahn et al. (Mar 2001) ‘Study Shows Damaged Blood Vessels Cause Low Back Problems.’ American Academy of Orthopaedic Surgeons.
6. Ekholm , Grønbaek M, Peuckmann V, Sjøgren P. (Jul 2009). Alcohol and smoking behavior in chronic pain patients: the role of opioids. European Journal of Pain.
7. Fahad Alkherayf, Eugene K Wai, Eve C Tsai and Charles Agbi. (Aug 2010). Daily smoking and lower back pain in adult Canadians: the Canadian Community Health Survey. Journal of Pain Research
8. Mitchell MD1, Mannino DM, Steinke DT, Kryscio RJ, Bush HM, Crofford LJ. (Aug 2011). Association of smoking and chronic pain syndromes in Kentucky women. Journal of Pain Research.
9. Bogdan Petre, Souraya Torbey, James W. Griffith, Gildasio De Oliveira, Kristine Herrmann, Ali Mansour, Alex T. Baria, Marwan N. Baliki, Thomas J. Schnitzer and Apkar Vania Apkarian. (Oct 2014). Smoking Increases Risk of Pain Chronification Through Shared Corticostriatal Circuitry. Human Brain Mapping.

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