Back pain refers to pain or discomfort in the dorsal (back) region of the body, which can arise from abnormalities in spinal vertebrae, back muscles, tendons, ligaments, or neural structures.  While back pain and other musculoskeletal injuries can usually be linked to an identifiable event, like lifting with improper form, there is often a history of stressors that have compromised the integrity of the tissues involved that precede the onset of back pain. Think of the adage about the straw that broke the camel’s back. Some of these stressors may not be related to physical activity at all. One such lifestyle factor that has been linked to an elevated risk for back pain is smoking.

The current literature suggests that smoking constricts blood vessels, which restricts blood flow and the delivery of nutrients to the tissues in the body, including the back. This can lead to inflammation, slower healing, disk degeneration, reduced bone density, and muscle fatigue—all factors that can increase the risk for back pain. Additionally, smokers are less likely to be physically active and more prone to anxiety and stress, which are also linked to an elevated risk for back pain.

In a large prospective cohort study that lasted nearly 13 years and included 438,510 adults, researchers observed that current smokers are 50% more likely to develop back pain than never smokers. Additionally, the risk for low back pain among smokers increases by up to 45% for those with a history of smoking exceeding 30 pack years (a pack year equaling 365 packs of cigarettes) or those who smoke 30 or more cigarettes a day. The risk of back pain is also higher among female smokers. Another study reported that smokers may develop inflammatory back pain at a younger age and experience a worse course of disease.

For smokers who develop back pain, a population-wide study conducted in Sweden in 2010 and published in 2022 found that daily smoking reduced the risk for a favorable prognosis by about 21%. In a 2023 study, examinations of 54 chronic low back pain patients revealed an association between cigarettes smoked per day and worse scores on assessments of pain intensity, fear-avoidance beliefs, and disability.

Time for some good news. An analysis of data from the English Longitudinal Study of Aging looked at data concerning 6,467 middle-aged and older men and women and found that those who stopped smoking experienced a declining risk for low back pain. In fact, their findings suggest that former smokers may have a similar risk for low back pain as never smokers if they can maintain smoking cessation for just four years. However, if they relapse in that time frame, the risk for back pain appears to be the same as those who continued to smoke.