The last 10 years have seen an inexplicable increase in functional disability caused by lower back pain. Despite improved treatments, pain and physical function in these patients is worsening in around 100 million U.S. patients. A simple symptom frequently devolves into a complicated condition affecting the entire central nervous system.

Several studies have drawn a link between smoking and lower back pain. A 50-year 2001 John Hopkins survey proposed a link, but at the time, the finding remained unproven and even unexplained. Researchers have since painted a fuller picture of the link. Smoking impacts upon knee, rotator cuff, and disc injuries because it:

  • Increases inflammation
  • Prevents healing
  • Reduces blood supply to wounds
  • Demineralizes bone
  • Impedes the supply of nutrients
  • Reduces bone metabolism
  • Increases the risk of postoperative infection

Lower back pain is associated with a sedentary lifestyle and high body mass index, but surveys are limited in that they use samples from hospital records. They consist of more surgical patients, which means they have higher rates of disability. This limits the survey to only the severest conditions. Those with mild back pain haven’t been covered quite as well.

Even so, smoking’s effect on wound healing is well understood, impacting upon everything from dental surgeries to burns. Nicotine and carbon monoxide constrict veins, limiting red blood cell transport and the macrophages needed for recovery. Oxygen transport to cells is also reduced by the hydrogen cyanide found in cigarettes.

Smokers also recover poorly from surgeries, which severely limits their treatment options.

The progress researchers have made in understanding smoking’s effects on back pain raises an important question. Should smokers be given an entirely different care strategy than nonsmokers? Doctors have wrestled with this problem for decades, but it can only be confronted on a case by case basis.

In any case, if you needed another reason to quit smoking in 2018, pain management makes the list.

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