Back & Neck Pain Prevention How Smoking Affects the Spine By Anne Asher, CPT Anne Asher, CPT Facebook LinkedIn Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. Learn about our editorial process Updated on October 21, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Stuart Hershman, MD Medically reviewed by Stuart Hershman, MD LinkedIn Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction. Learn about our Medical Expert Board Print Back pain is one of the many health risks of smoking. But exactly how does exposure to nicotine damage spinal structures? Wavebreakmedia / Deposit Photos Blood Vessel Constriction One way is that it affects blood vessels. Smoking may constrict and/or lead to the degeneration of arteries that supply the vertebrae with blood. According to Dr. Jennifer Solomon, a physiatrist at the Hospital for Special Surgery in New York City, "When you decrease the blood supply you decrease the oxygen and nutrients to these living structures. This, in turn, leads to degeneration and pain." Increased Spinal Fracture Risk "Back pain and fractures from osteoporosis are big issues in people who smoke," observed Dr. Rick Delamarter, co-director, Spine Center, and vice chairman, Spine Services, Department of Surgery, at Cedars-Sinai in Los Angeles. Delamarter added that if you are "deconditioned" and weak (in other words, if you don’t exercise) your risk for fractures increases even more. Smoking may interfere with bone metabolism. A 2003 review in the Journal of Internal Medicine of 50 studies that involved 512,399 people found that people who smoked were at an overall higher risk of bone fractures, including spinal fractures. The same review found that quitting smoking seemed to help decrease overall fracture risk. Smoke inhalation may reduce the ability of your cells to take in nutritional substances, according to Dr. Alexander Vaccaro who is an attending surgeon, in orthopedics and neurosurgery at Thomas Jefferson University Hospital in Philadelphia. Spinal Fusion Surgery Outcomes And healing after spinal fusion surgery will likely be more difficult if you smoke, as it raises your risk for a pseudoarthrosis (non-union of fusion). This may mean you will need a second surgery. It may also increase your chronic pain levels on a day-to-day basis. "In general, smoking inhibits the body's ability to heal from injury or surgery,” Dr. Solomon comments. "For current and former smokers whose discs heal poorly after a back surgery, this can mean a painful quality of life." Pressure on Intervertebral Discs If you’ve got a chronic cough, you likely will put repeated pressure on your interverbal discs, which can lead to disc herniation or degenerative disc disease. Back Pain Intensity In addition to the potential problems listed above, if you are a smoker, chances are good that your pain is more pronounced than that of a typical non-smoker with back pain, according to Dr. Solomon. You would think, based on the analgesic (pain reducing) qualities of nicotine, that smokers would have less back pain than non-smokers. Not so, Solomon says. What seems to happen is that an addicted smoker's pain tolerance is reduced when he or she is deprived of nicotine, she said. Nicotine deprivation may also hasten the onset of pain perception. "Because of this, some believe that nicotine withdrawal could increase a smoker's perception and even the intensity of their chronic pain," said Dr. Solomon, concluding that more research needs to be done before the relationship between pain perception and smoking is understood. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 0 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Email Interview. Solomon, Jennifer MD. Hospital for Special Surgery. New York. Jan 2012. Email Interview. Truumees,E. MD. Seton Spine and Scoliosis Center. Austin, TX. Feb. 2012. Rick B. Delamarter, MD. Co-Medical Director, The Spine Center and Vice Chairman for Spine Services, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles. Telephone Interview. Jan 2012. Shiri et al. The association between smoking and low back pain: a meta-analysis. AmJ Med. 2010 Jan;123(1):87.e7-35. Vaccaro, A. Spine: Core Knowledge in Orthopaedics. Elsevier Mosby.205. Philadelphia. Vestergaard P, Mosekilde L. Fracture risk associated with smoking: a meta-analysis. J Intern Med. 2003 Dec;254(6):572-83.