It has long been known that smoking interferes with the synthesis of collagen. Collagen is the protein that forms ligaments, tendons and the intervertebal discs. It also gives firmness to the skin, which is why smokers tend to look older than non-smokers—more wrinkles. Research in the March, 2004 issue of the journal Spine found that nicotine inhibits the ability of the cells of the intervertebral disc to reproduce and synthesize cartilage. Nicotine may contribute to disc degeneration—a common cause of back pain.

In fact, research appearing in the same journal in 2002 found that after collecting information on more than 25,000 patients, smokers who saw physicians for back pain reported more sever back problems than now smokers. Also, in back patients who have had surgery for their back problems, non-smokers have better outcomes than smokers.

Smoking, in general can increase pain. Research appearing in the Annals of Rheumatic Diseases (2002;62:33-36) found that smokers had about a 50% greater chance of experiencing severe pain (pain severe enough to keep the subject from going to work or from performing normal daily activities). Other research appearing in the journal, Spine (Dec. 1, 1999:24(23), pp2492-96) found that teenagers who smoked experienced back pain twice as often as those who did not smoke. The subjects of the study were high school students form Montreal, Canada.