How smoking can affect spine health and cause back pain

Smoking has long been associated with various health risks, such as lung disease, but its detrimental effects on the spine are lesser known. Degenerative spine diseases (DSDs), particularly those affecting the intervertebral discs, cervical, and lumbar regions, are commonly linked to smoking. Research indicates that smoking can contribute to conditions like spinal stenosis and degenerative disc disease, with a higher risk of issues in the lumbar spine.

If you have back pain, smoking may end up worsening it and also accelerate spondylosis. Since nicotine restricts blood flow to the spine, thus making it difficult for nutrients and oxygen to reach vital areas, it can result in inflammation and tissue damage. In fact, if a patient is recovering from spinal surgery, it can make the progress more challenging. Smoking can also potentially put one at greater risk of fractures as nicotine signals the brain to eat less, leading to weight loss, and preventing the body from the necessary nutrition.

Smoking can directly affect the spine as there is a lack of nutrients, especially where the bone meets the spine disk, according to experts, affecting the regeneration of cells as well. Doctors usually recommend that patients quit smoking 4-6 weeks before undergoing spinal surgery and continue the practice for at least a month after surgery, to improve outcomes.

Since nicotine interferes with the body’s ability to form new blood vessels and hinders tissue repair and fusion, which is critical for healing fractured vertebrae, recovery can be far slower for smokers. This can lead to delay in healing and increased risk of post-surgery complications, besides low success rate in spinal fusion procedures. It’s worth mentioning that besides nicotine, cigarettes also contain other toxic substances, such as cadmium, lead, nickel and chromium, carbon monoxide, etc.

Meanwhile, a study published in the Annals of the Rheumatic Diseases reported that smoking, on its own, raised the risk of back pain by about 30 percent, after having adjusted for job stress and other factors that may cause back pain. For this study, British researchers surveyed 13,000 people on their lifestyles, including their smoking habits, jobs, activity levels, and history of pain. Smoking, the researchers observed, also seemed to make people more vulnerable to pain in other parts of the body, for instance, the neck, shoulders, elbows, hands, hips, and knees.

The scientists also noted that nicotine from cigarettes "could affect the manner in which the brain processes sensory stimuli and the central perception of pain", or rather, it has an impact on how the brain sends pain signals. Smoking, thus, is believed to heighten the perception of pain. This means that back pain, which might be manageable for a non-smoker, could feel more intense for someone who smokes​.

According to research, smokers are nearly 50 percent more likely to need spinal surgery than non-smokers. Smoking also increases the risk of developing a spine fracture by 32 percent in men and 13 percent in women. Studies have also shown that compared to men, female smokers were at more risk of developing back pain. Not smoking, quitting smoking, and reduction in the habit could lower the risk by up to 18%. Other studies have pointed to a link between lumbar pain and sciatica. Smokers are 50% more likely to need spinal surgery than non-smokers. In a Swedish study, smokers (up to 14 cigarettes a day), were 46% more likely to have spinal surgery as compared to people who never smoked. However, ex-smokers had 13 percent higher odds of surgery.

These are some ways that smoking affects spine health:

⦁ It increases the risk of osteoporosis as smokers are prone to reduced bone density. It weakens spinal muscles as well.

⦁ It negatively impacts nutrient levels such as Vitamins D and C, while reducing immunity.

⦁ People who smoke tend to be less physically active and thus get less exercise.

The link between smoking and spine health is often overlooked, but it is clear that smoking accelerates spinal degeneration, impairs recovery, and increases the risk of chronic back pain and bone fragility. The good news is that many of these issues can improve after quitting. This is particularly important for older adults who are already at higher risk for bone-related injuries. By stopping smoking, blood flow improves, giving tissues and spinal discs a better chance to repair themselves. This can lead to a reduction in back pain and a lower risk of further degeneration​.

Inputs from Dr. Harnarayan Singh, Director & HOD, Department of Neurosurgery, SHALBY Sanar International Hospitals, Gurugram