Why does my upper back hurt when i smoke

I've been having some trouble with back pain off and on over the last six months. Right now it's more on than off. My doctor tells me quitting smoking would help. Is it enough to cut back the number of cigarettes I smoke?

Your doctor has given you good advice. Nicotine in cigarettes closes down the blood vessels. This is called vasoconstriction. The result is a loss of oxygen and nutrition to the back. This includes muscles, tendons, ligaments, bones, and discs.

The risk of disc problems is increased in smokers. Smokers tend to have disc problems throughout the spine, not just at one or two levels. Some studies show that the number of cigarettes smoked each day does make a difference.

Quitting tobacco use is the best for your overall health, not just to reduce back pain. If you can't quit then cutting back as much as possible is the next best step.

Saud M. Al-Obaidi, PT, PhD, et al. Differences in Back Extensor Strength Between Smokers and Nonsmokers With and Without Low Back Pain. In Journal of Orthopaedic & Sports Physical or Occupational Therapy. May 2004. Vol. 34. No. 5. Pp. 254-260.

A construction worker might blame his jackhammer for his sore back. An office worker might chalk up the ache to an uncomfortable chair. Fair enough. But if either person happens to be a smoker, there just might be a different explanation for his or her pain.

In recent years, researchers have uncovered a surprising connection between smoking and back pain. In study after study, smokers seem to be more likely than nonsmokers to suffer sore backs. The trend holds for men and women, manual laborers and white-collar workers. The investigations raise interesting questions about the root causes of pain. On a more practical level, they also give smokers a whole new reason to quit.

A study published in the Annals of the Rheumatic Diseases drives the point home. British researchers asked 13,000 people about their lifestyles, including their smoking habits, jobs, activity levels, and history of pain. After adjusting for the demands of strenuous jobs and other factors that might cause back pain, the scientists concluded that smoking -- by itself -- raised the risk of debilitating back pain by about 30 percent. Smoking also seemed to make people slightly more vulnerable to pain in the neck, shoulders, elbows, hands, hips, and knees.

Their report is not alone in its conclusions. A review of over 40 studies published in the journal Spine concluded that "the data are fairly consistent that smoking is associated with... low back pain." A 2008 study published in the same journal noted that regular smoking in adolescence was associated with lower back pain in young adults, especially among girls.

How could smoking cause back pain?

Scientists aren't sure why some smokers are prone to back pain. According to the report in the Annals of the Rheumatic Diseases, nicotine from cigarettes "could affect the manner in which the brain processes sensory stimuli and the central perception of pain" -- in other words, cigarettes affect the way the brain sends its pain signals. Smoking may also damage tissue in the lower back and elsewhere in the body by slowing down circulation and reducing the flow of nutrients to joints and muscles, according to the journal.

Even after 40-plus studies, however, researchers are leaving open the possibility that the link between smoking and back pain could be a coincidence. As reported in Spine, an overlooked trait such as depression or anxiety could cause back pain AND makes people more likely to smoke. Or maybe smokers develop certain behaviors -- like coughing or stooping to find lost cigarettes -- that make them more prone to back pain.

Should I give up smoking for the sake of my back?

The data may still be a little fuzzy, but the message is clear. As reported in the New England Journal of Medicine, smokers who suffer from back pain have every reason to kick the addiction. Giving up cigarettes probably won't immediately banish back pain, but it just might help. Of course, quitting smoking will also dramatically lower the risk of heart disease, cancer, emphysema, and a host of other diseases. Back pain or no, that's a great comfort.

References

Palmer, K.T. et al. Smoking and musculoskeletal disorders: Findings from a British national survey. Annals of the Rheumatic Diseases; 62: 33-36.

Goldberg, M.S. et al. A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes. Vol.25 (8): 995-1014.

Deyo, R.A. and J.N. Weinstein. Primary care: Low back pain. New England Journal of Medicine. Vol. 344 (5) 363-370.

Mikkonen, P, et al. Is smoking a risk factor for lower back pain in adolescents? A prospective cohort study. Spine; 33(5): 527-32.

image credit: Shutterstock

Forty-two million Americans smoke cigarettes. On November 19, the American Cancer Society will hold the Great American Smokeout’s to encourage smokers to kick the habit for good. Need another reason to quit? Studies show that smoking contributes to chronic back pain.

According to new research, smokers are more likely than nonsmokers to suffer from an aching back. A study published in the Annals of the Rheumatic Diseases concluded that smoking raised the risk of debilitating back pain by about 30 percent. Smoking also causes people to be more vulnerable to pain in the neck, shoulders, elbows, hands, hips and knees.

How could smoking cause back pain?

Smoking damages tissue in the lower back by slowing down circulation and reducing the flow of nutrients to joints and muscles, increasing degeneration. Nicotine reduces calcium absorption and prevents new bone growth. Smokers have double the risk of an osteoporotic fracture.

Also, smoking causes pain because cigarettes affect the way the brain sends its pain signals.

Should I give up smoking for the sake of my back?

As reported in the New England Journal of Medicine, smokers who suffer from back pain have every reason to say no to cigarettes. Giving up smoking won’t immediately stop back pain, but it will help. If you need more encouragement, quitting also dramatically lowers the risk of heart disease, cancer and many more diseases.

For more information on how to ease your aching back, call us at 253-841-8939 to make an appointment today.

According to the Centers for Disease Control and Prevention (CDC), an estimated 14% of Americans are current smokers, and therefore at risk for a number of smoking-related conditions. Low back pain is one such condition that has a strong association with smoking.

Specific findings in research show:

• The more frequently one smokes, the greater the risk of back pain1
• Smokers with low back pain also tend to have pain in the leg, usually extending below the knee2

Smoking may change the level of nutrients, such as cholesterol and vitamins, in the blood and the health of organs, such as the heart and the lungs. While these metabolic changes may help explain the link between smoking and a degenerating spine, it remains to be seen if smoking is a cause of back pain.

Smoking Alters Blood Flow and May Lead to Back Pain

Consequences of smoking may indirectly contribute to the development of degenerative lumbar spine problems. These consequences include, but are not limited to1,3-5:

• Hypertension, or high blood pressure. A history of cigarette smoking impairs the ability of the endothelium (the thin membrane of cells lining the blood vessels) to regulate blood pressure, causing hypertension (elevated blood pressure) in some individuals.
• Abnormally high blood cholesterol. High levels of cholesterol, also known as hyperlipidemia, can go undetected but increase the risk of developing coronary artery disease.
• Atherosclerosis, or narrowing of the arteries. Atherosclerosis is aggravated by hypertension and abnormal cholesterol levels.

Atherosclerosis causes decreased blood flow to organs and tissues and may result in ischemia. Atherosclerosis in the aorta (a main artery of the heart) and ischemia in the leg have long been considered potential causes of low back pain and intervertebral disc degeneration.6-8

Passive smoking,9 also called second-hand smoking, and waterpipe tobacco smoking,10,11 commonly known as hookah, similarly contribute to abnormal blood pressure and cholesterol. The combination of cigarette smoking and waterpipe smoking may increase cholesterol levels higher than either type of smoking alone.12

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Smoking reduces the nutrient content of the blood that is delivered to the intervertebral discs and joints of the spine. Studies have drawn conclusions about whether or not the following effects of smoking play a role in back pain:

• Low vitamin D. Smoking alters the speed of vitamin D production,13 the amount of vitamin D circulating in the blood,14 and the number of vitamin D receptors.15 Gradually, these effects may lead to vitamin D deficiency. Moderate deficiency of vitamin D has the potential to decrease bone density, which may contribute to the development of bone fractures.16 The association between vitamin D deficiency and low back pain is well-established,17 but may only exist for certain subgroups such as women less than 60 years old18 or individuals with severe vitamin D deficiency.19
• Low vitamin C. Smokers generally metabolize vitamin C faster and have lower vitamin C levels in the blood as a result of the rapid metabolism.20 While vitamin C has been a factor of interest in low back pain research, vitamin C deficiency does not explain the link between smoking and back pain.

More research is needed to explore the possible ways that smoking leads to prolonged and more frequent episodes of back pain. Targeted treatments, such as vitamin C supplements, can be tailored to current or former smokers with back pain or at risk of developing back pain, once the association is better understood.

Smoking Promotes the Development of Chronic Back Pain

Smoking also has certain effects on brain circuitry. Back pain is more likely to become chronic in smokers, possibly due to the cooperation of specific areas of the brain— the nucleus accumbens and the medial prefrontal cortex.21 These regions of the brain are known for their role in many cognitive functions, such as reward, addiction, and habit formation. The connection between these brain regions weakens after quitting smoking.

Back Pain After Quitting Smoking

The habit of smoking is an important obstacle to overcome, and one way that smoking cessation may pay off is with a reduced risk of back pain.

Former daily smokers may experience generalized body pain, including back pain, that continues or begins after smoking cessation.22 After quitting, nicotine withdrawal causes the level of serotonin in the brain to decrease. With lower serotonin levels, the sensitivity to pain increases.23 Smokers with chronic pain may be advised to quit smoking gradually or to alleviate withdrawal symptoms using nicotine patches.

Watch Quitting Smoking: A Must for People with Back Pain Video

The neurological and vascular effects of smoking on the back can be reduced by quitting, but cannot be fully reversed. Both current and former smokers are at risk for numerous conditions, including low back pain and degenerative disc disease, because of the lingering effects of smoking.

See When to Quit Smoking

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Factors such as age, gender, and history of spinal conditions may turn the dial up on the influence that smoking has on the spine. Research studies of hundreds of individuals have supported the following findings:

• Adolescents who smoke were up to 2.4 times as likely to experience low back pain compared to nonsmoking adolescents.24
• Adult smokers were about 30% more likely to have low back pain compared to nonsmoking adults.25
• Men who smoke were 18% more likely to have low back pain, 25% more likely to have disc degeneration, 33% more likely to have spinal instability, 49% more likely to have spondylolisthesis, and 52% more likely to have spinal stenosis compared to nonsmoking men.26
• Women who smoke were 50% more likely to experience chronic back pain compared to women who never smoked.27
• Smokers with a history of adolescent idiopathic scoliosis are more likely to have back pain than smokers without the condition.28

Both back pain and associated leg pain are less common in former smokers than in current smokers,11 so quitting smoking may alleviate back pain and may also improve outcomes after back surgery.29

See Ways to Quit Smoking