We all know smoking is bad for you but can it be causing your lower back pain?

It might sound like a no-brainer but it’s difficult to ascribe a cause-effect relationship here.

First of all, beyond serious pathology and an acute injury of the lumbar spine, ‘disabling low back pain (LBP) is best seen as neurobiological and behavioral responses to individuals’ actual and/or perceived threat to their body, lifestyle, or social circumstances and/ or disruption to their homeostasis (1).’  In other words, pain overall is very multifactorial and its contributing constituents are individual to the person. Pain can modulate depending on a number of factors which interact and are influenced by genetics, pathoanatomy, physical, psychological, social, lifestyle and other health factors.

And smoking goes under the ‘lifestyle’ department here.

So assuming the interplay of these factors at any given moment influences our experience of pain, it’s hard to discretely say that smoking solely causes lower back pain. There are smokers out there who do not experience pain, so that throws that claim out the window. And perhaps the smokers that visit physicians and are part of research studies just happen to be smokers.

OK, enough of the reasoning. Let’s see what the literature says.

Overall, the association between smoking and low back pain is modest. When taking a broad sweep of the data out there, here are some interesting findings:

  • former smokers had a lower prevalence of low back pain than current smokers
  • the association between current smoking was higher in adolescents than adults
  • smokers usually have poorer mental health status than nonsmokers and could be interpreted as a surrogate marker for psychological health issues. (2)

Also important to note is that in order to test to see if smoking actually causes lower back pain, they’d have to have human test subjects with no back pain smoke for their studies which is highly unethical.

Chicken or egg?

It’s a logical jump to say, ‘you’re a smoker. It’s unhealthy. It makes sense that smoking causes lower back pain.’ But again, most lower back pain cases have ‘nonspecific’ causes, which means the origin is unknown. (for more on the latest facts on back pain, read them here). And it so happens that most people have degenerative change in their lumbars whether they’re in pain or not. Does this mean there’s a direct link between smoking and degenerative change?

Not a lot of studies have looked into this link. It’s not very well understood.

Here’s what is purportedly occurring at the cellular level when one smokes:

  • the carbon monoxide in cigarettes leads to malnutrition of the cells in intervertebral (IVD) discs
  • reduces nutritional supply to the discs and limits ability to remove harmful wastes
  • the chemicals found in cigarettes might impact the homeostasis of the intervertebral disc cells leading to degeneration
  • might predispose people to morphological changes AKA disc prolapse and disc herniation (3)
  • creates a low-level systemic inflammation (4)

I can smoke all I want! 

This is not a promotional blog post to smoke willy nilly now. Smoking has detrimental health effects and you’d be digging your head in the sand if you deny that. It’s just unclear to determine how exactly smoking affects lumbar spine health and if this degeneration does indeed lead to pain in people.

Could it be that smokers make poorer lifestyle choices which can make people more susceptible to pain? YES!

Is it healthier to quit or not smoke regardless if it influences spinal degeneration or not? Of course!

Could smokers we read about in studies just coincidentally have back pain and are dealing with other stressors? Perhaps.

We know for sure smoking is unhealthy for spinal health but it’s still unclear on distinct pathways. It’s better for your health to not touch cigarettes anyway.

Overall, it is my assertion we see the whole person and the interplay of factors (biophysical, social, psychological) that summarily leads to the output of pain. Lifestyle factors such as sedentariness, low level of activity, smoking, being obese, and poor sleep may predispose you to pain but it’s not guaranteed.

You’re doing yourself a favor when you practice healthier behavior(s).


  1. O’Sullivan, PB, Caneiro, JP, O’Keefe, M., Smith, Anne, Dankaerts, W., Fersum, KV, O’Sullivan, K (2018). Cognitive Fnctional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408-423. 
  2. Shiri, R., Karppinen, J., Leiono-Arjas, P., Solovieva, S., Viikari-Juntura, E. (2010). The Association between Smoking and Low Back Pain – A Meta-Analysis. The American Journal of Medicine, 123, 87.e7-87.e35, doi:10.1016/j.amjmed.2009.05.028.
  3. Jackson, AR., Dhawale, AA., Brown, MD. (2015). Association between Intervertebral Disc Degeneration and Cigarette Smoking: Clinical and Experimental Findings. JBJS REVIEWS 2015;3(3):e2 · http://dx.doi.org/10.2106/JBJS.RVW.N.00057
  4. Yanbaeva, DG., Dentener, MA., Creutzberg, EC., Wesseling, G., Wouters, EFM. (2007) Systematic Effects of Smoking. Chest Journal, 131(5), doi:10.1378/chest.06-2179.





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