Even with all of the negative health effects, it may seem unlikely that a habit like smoking could lead to back pain, but research is now showing that smoking is one of the main risk factors for developing back pain. Not only that, smoking can intensify pain and delay healing of injuries all over the body.

A 2014 study out of Northeastern University found that smokers had three times the likelihood of developing chronic back pain than non-smokers. The longitudinal study monitored 160 adults five times a year with MRI brain scans and questionnaires about back pain and other health issues. Another 35 healthy adults acted as a control group. Thirty-two non-smoking adults with back pain rounded out the study.

Researchers examined the activity between two areas of the brain that are connected to addictive behavior and learning (nucleus accumbens and medial prefrontal cortex, NAc-mPFC). The conversation between these two areas of the brain contributes to the development of chronic pain. Researchers noted that the connection between these two areas was especially strong in smokers, indicating a strong tendency towards chronic pain.

As if that tendency to chronic pain was not enough, researchers have also found that a toxin in cigarette smoke can actually increase pain in patients with spinal cord injury.

Acrolein is a toxin in cigarettes that was found to affect pain levels in mice with minimal exposure – just 12 cigarettes a day. Nerve cells damaged by spinal cord injury or conditions such as multiple sclerosis naturally produce acrolein. The protective myelin sheath surrounding the nerve cells is damaged, and production increases in these types of conditions. Smoking stimulates acrolein production even more.

This is the first study that connects increased levels of acrolein in smokers with increased pain due to spinal cord injury. Researcher Riyi Shi, a professor in Purdue University’s department of basic medical sciences, college of veterinary medicine, and Weldon School of biomedical engineering noted that:

“The data indicated that acrolein is absorbed into the circulatory system and some enters the nervous system. It is expected that these findings may facilitate further studies to probe the pathological role of acrolein in the nervous system resulting from smoke and other external sources through long and short term, both active and passive exposure.”

Smoking also blocks the body’s response to treatment of inflammatory back conditions, especially for a specific type of low back inflammatory arthritis called axial spondyloarthritis, or AxSpA. Researchers published these findings in the Annals of the Rheumatic Diseases. A cohort of 700 patients with AxSpA, two-thirds of whom were smokers, were tracked from 2005 to 2014. For various reasons, complete treatment data was available for only 70% of patients (slightly fewer than 500). Controlling for factors like age, sex, and duration of symptoms, researchers found that current smokers experienced significantly less relief from treatment, particularly among those current smokers who had a higher level of inflammatory marker to begin with (indicating a more intense inflammatory response at the start).This may be due to smoking causing an increase in the inflammatory marker, or it may be that smoking again affects the brain by blocking neural processing.

In light of the research above, it may seem a foregone conclusion that, due to smoking’s effect on the brain, smokers are doomed to back pain, but this is not so. Quitting smoking can re-wire the brain and reverse the effects of smoking. Bogdan Petre, lead author of the study and a technical scientist at Northwestern University Feinberg School of Medicine, had this to say about the possibly of healing by smoking cessation:

“…we saw a dramatic drop in [the activity in the brain that contributes to chronic pain] in smokers who — of their own will — quit smoking during the study, so when they stopped smoking, their [vulnerability] to chronic pain also decreased.”

Quitting smoking has benefits that start just 20 minutes after your last cigarette. What happens to your body when you quit smoking?

  • Within 20 minutes of your last cigarette: Your heart rate slows
  • Within one hour: Carbon monoxide, a toxic gas that is a by-product of smoking, drops to normal levels in your blood
  • Within two weeks to three months: Your risk of heart attack begins to drop
  • Within nine months: Your lungs begin to function properly, reducing the chance of lung infections and illness
  • Within one year: Your risk of heart disease plunges to just half that of a smoker’s
  • Within five years: Your risk of stroke is the same as a person who has never smoked
  • Within ten years: Your risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases dramatically, and your chance of dying from lung cancer is half that of a smoker’s
  • Within 15 years: Your risk of heart disease is the same as that of a non-smoker

Quitting smoking can be very challenging as it involves not only a physical addiction but also a behavioral habituation. It is a habit that needs to be removed from a person’s day, a habit that marks particular times (with coffee in the morning, or during a break at work) or particular activities (socializing with friends). A multi-pronged approach is necessary to help ensure success.

First, make your intentions known. Tell family, friends, and coworkers you are quitting. They may want to join you!

Next, get support. Use tools from the American Cancer Society to keep you on track. Understand that it may take several attempts to quit for good, and don’t be hard on yourself if you slip up.

Finally, follow general guidelines for keeping your health resolutions. This includes things like SMART goal setting and coming up with a plan that includes replacing a bad habit with a good one (e.g., finding something to do with your hands, like knitting, or drinking a glass of water every time you have the urge to smoke).

The U.S. Surgeon General says that quitting smoking is the single best thing you can do for your health. Take the first steps to a healthier brain and a pain-free back by quitting today!

Image by machechyp via Flickr


Weekly updates on conditions, treatments, and news about everything happening inside pain medicine.

You have Successfully Subscribed!