The Link Between Smoking and Chronic Pain


Chris Iliades, MD

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RA's Impact Goes Beyond Joints

How Doctors Diagnose Chronic Pain

Pain presents a special challenge for doctors. After all, no lab test or X-ray can tell them exactly what your pain feels like.

You already have plenty of good reasons not to smoke, but a study performed at the University of Kentucky linked smoking to chronic pain in women. The study surveyed more than 6,000 women over age 18 about their smoking habits and chronic pain symptoms. Chronic pain is the type of pain that lasts a long time. The types of pain asked about included neck pain, back pain, joint pain, nerve pain, headache, and pain all over the body. 

The study, published in the Journal of Pain, found not only that women who smoke have more pain, but also women who are former smokers have more pain. Former smokers had a 20% increase, light smokers had a 68% increase, and daily smokers had a whopping 104% increase in chronic pain. 

Other Studies Linking Smoking and Chronic Pain

The link between smoking and chronic pain is not new and not limited to women. A review of 47 studies done on smoking and low back pain between 1974 and 1996 found that many of the studies linked smoking to low back pain. Here are some other types of pain that have been linked to smoking:

  • Smoking for more than 15 years has been found to increase the risk of sciatica (spinal nerve pain).

  • Smokers treated at pain rehabilitation centers for facial pain or for fibromyalgia (pain all over the body) have been found to have more pain and more disability from pain than nonsmokers.

  • Smoking more than a pack of cigarettes per day has been associated with more disability from knee pain in men.

  • A study of patients recovering from heart bypass surgery found that smokers required 33% more pain medication than nonsmokers in the first two days after surgery.

What Is the Link Between Smoking and Chronic Pain?

The short answer is that we don't exactly know. Since smoking is basically a delivery system for nicotine, most experts think that nicotine is the link. But there are about 3,000 chemicals and toxins in cigarette smoke, and many of them could contribute to chronic pain. Here are some things we do know about smoking and pain:

  • Nicotine is known to decrease sensitivity to pain in the early stages of pain, but that decreased sensitivity eventually wears off. Once the pain-decreasing effect of nicotine wears off, pain may actually be worse. So one theory is that people start to smoke to relieve acute (new) pain and then need to keep smoking to relieve chronic pain.

  • Smoking decreases the amount of oxygen your blood delivers to body tissues. That's why smoking can cause the thinning of bones called osteoporosis and makes it harder for your body to heal and repair damage after an injury. Inadequate bloodflow to tissues causes oxygen starvation (ischemia) and interferes with the body's own ability to regulate inflammation. These could be additional causes of chronic pain.

  • Smoking is also common in other conditions that have been associated with chronic pain. These conditions may contribute to the smoking-chronic pain link. Conditions in which both smoking and chronic pain are common include depression, drug and alcohol abuse, lower education, poverty, unemployment, and divorce. These conditions may make it harder for people to cope with chronic pain.

What Can We Learn From Studies About Smoking and Chronic Pain?

For one thing, an increased risk for chronic pain is one more reason to quit smoking or not to start. Smoking is the #1 cause of preventable death in America, but one in five Americans continues to smoke. Obviously, getting people not to smoke is important, but studies on smoking and chronic pain leave us with some unanswered questions:

  • Could helping people stop smoking help in the treatment of chronic pain?

  • Could better treatment of chronic pain help people stop smoking?

  • Could withdrawal from smoking actually make chronic pain worse?

More research is needed to answer these questions. The bottom line is that the risk of living with chronic pain is one more reason not to smoke.

Key Takeaways

  • Smoking has been linked to chronic pain by many studies.

  • Smoking decreases your body's ability to heal itself.

  • Smoking is more common in stressful conditions that make chronic pain harder to cope with.

  • Future studies are needed to learn more about treating people with chronic pain who smoke.

  • The risk of chronic pain is one more good reason not to smoke. 

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jun 21, 2017

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Medical References

  1. Shi Y et al. Smoking and pain: pathophysiology and clinical implications. Anesthesiology. 2010;113(4):977-92.
  2. Mitchell MD, et al. Association of smoking and chronic pain syndromes in Kentucky women. Journal of Pain. 2011;12(8):892-9.

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