Low back pain affects 80 percent of us at some point in our lives. As a result, researchers are working diligently to determine what factors contribute to this pain. Some of the factors that have been identified include an occupation requiring a heavy physical workload, low levels of leisure physical activity, high body mass index, living in a small community, having a low educational level and being a smoker [Source: Bjorck-van Dijken, Freedman, Leboeuf-Yde, Mikkonen]. While some of these factors may seem like common sense, some may be more surprising to you. The primary goal of this article is to present some evidence as to the effects smoking has on back pain and some possible explanations as to why.
It would seem logical that the more demand an activity or load places on the spine, the more likely it is that the spine may become injured. If the spine is injured, pain is likely to result. This is the obvious explanation as to why high body mass index and heavy occupational workloads tend to be associated with low back pain. However, an important factor with chronic loading of any part of the body is how well the body can recover or heal from the small damage caused by the loading. Ideally, the body heals a little stronger than it started and is more resistant to that same load in the future. If the body is not able to heal sufficiently, further injury develops. The key to healing is providing sufficient time between when the demand is placed on the body and the area of the body having enough blood supply to provide healing. An example of the time factor is a blister on your foot. Given enough time the blister will heal and the foot will be ready for taking stress once again. If the stress that created the blister is small and time is given between when the stress is applied, a callous forms instead of a blister. The body adapts instead of being injured. In the case of blood supply, think of the inside of your lip. This area has a rich blood supply and if cut will heal quite fast. The spine is similar. If it has a good blood supply, it will adapt to the physical demands placed on it. If the demand is too great, damage will occur.
One of the chief effects of smoking on the spine is that smoking contributes to atherosclerosis. Atherosclerosis is when plaque or other material builds up on the inside of blood vessels, causing decreased blood supply especially to areas that are fed by very small vessels. The bones and discs of the spine are supplied by these small vessels and are affected by atherosclerosis which decreases the spine’s ability to heal itself. This eventually leads to degeneration of the spine and the onset of pain. In this way, smoking increases the risk of developing atherosclerosis related to back pain [Source: Kaupplia, Leino-Arjas].
Also related to the spine’s ability to heal is the role of a bone cell called an osteoblast, a specialized cell the builds bone tissue. Nicotine is a major chemical in smoking that contributes to its addictive properties. However, nicotine also inhibits the activity of osteoblasts [Source: Glowacki]. Decreased osteoblast activity from nicotine causes the bones of the spine to have a reduced ability to rebuild. Over time, the bone is used up faster than it can be rebuilt causing osteoporosis and other degenerative conditions causing pain.
Another connection that has been made between smoking and low back pain is the message of pain itself. Smokers have been found to have higher ratings of pain than nonsmokers [Source: Ackerman, Scott, Vogt]. While the exact reasons for this are not entirely clear, it appears to have some connection with chemical interference with the body’s natural hormonal activity for pain detection. Essentially, the hormones and chemicals that help the body deal with pain are inhibited by smoking.
Other questions about smoking include whether smoking has an effect on intervertebral discs or on neck pain. At this time there is no conclusive evidence of smoking causing either of these conditions [Source: Gore, Leboeuf-Yde]. We may find that there is a link with further research. However, even if it is found that smoking does not cause disc problems or neck pain, the fact remains that smokers will tend to have more feelings of pain if there is an injury caused by something else.
The body is a remarkably resilient system. It can adapt and heal. However, it is also susceptible to harmful influences. It is up to each of us to take care of our own bodies and limit those harmful things by the choices we make. Smoking cessation, exercise and an improved diet are all personal decisions and habits that can be improved. Your body will thank you.
- Ackerman WE 3rd, Ahmad M. Effect of cigarette smoking on serum hydrocodone levels in chronic pain patients. J Ark Med Soc. 2007 Jul; 104(1): 19-21.
- Bjorck-van Dijken C, Fjellman-Wiklund A, Hildingsson C. Low back pain, lifestyle factors and physical activity: a population based-study. J Rehabil Med. 2008 Nov; 40(10):864-9.
- Freedman MK, Sauline MF, Overton EA, Holding MY, Kornbluth ID. Interventions in chronic pain management: approaches to medication and lifestyle in chronic pain syndromes. Arch Phys Med Rehabil. 2008 Mar; 89(3 Suppl 1):556-60.
- Glowacki J, Schulten AJ, Perrott D, Kaban LB. Nicotine impairs distraction osteogenesis in the rat mandible. Int J Oral Maxillofac Surg. 2008 Feb; 37(2):156-61.
- Gore DR, Carrera GF, Glaeser ST. Smoking and degenerative changes of the cervical spine: a roentgenographic study. Spine J. 2006 Sep-Oct; 6(5):557-60.
- Kaupplia LI. Atherosclerosis and disc degeneration/low back pain - a systematic review. Eur J Vasc Endovasc Surg. 2009 Mar 25.
- Leboeuf-Yde C, Kjaer P, Bendix T, Manniche C. Self-reported hard physical work combined with heavy smoking or overweight may result in so-called modic changes. BMC Musculoskelet Disord. 2008 Jan 14; 9:5.
- Leino-Arjas P, Solovieva S, Kirjonen J, Reunanen A, Riihimaki H. Cardiovascular risk factors and low-back pain in a long-term follow-up of industrial employees. Scand J Work Environ Health. 2006 Feb; 32(1): 12-19.
- Mikkonen P, Leino-Arjas P, Remes J, Zitting P, Taimela S, Karppinen J. Is smoking a risk factor for low back pain in adolescents? A prospective cohort study. Spine. 2008, Mar 1;33(5): 527-32.
- Scott SC, Goldberg MS, Mayo NE, Stock NE, Poltras B. The association between cigarette smoking and back pain in adults. Spine. 1999, Jun 1;24(11):1090-98.
- Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine. 2002 Feb 1;27(3): 313-19.