Up in Smoke

[originally published in KCN, March 2000]

smoking-camelI wonder what Joe Camel’s spinal X-rays look like.  Not very pretty in my estimation.  In fact, I’m even starting to question whether he really is  a camel after researching the impact cigarettes can have on the spine.  Perhaps under his cool camel persona lies a spinal deformed horse with a bad nose job.  If so, kudos to the ladies and gentlemen in Joe’s marketing department for fooling us all for so long.

Bad addictionSo what’s up with smoking and spinal health anyway?  Is there a link?  Will the courts order tobacco companies to provide lifetime chiropractic care for their puffing patrons?  Probably not.   After all, the bad habit hasn’t been “conclusively” linked to poor spinal health.  Hmmm.  Nevertheless, the physiology of the spine and pharmacology of the potent chemicals in cigarettes suggests that a connection is very plausible.

But it’s more than a good exercise in medical deduction — for some health professionals it’s a matter of x-ray imagesuccessfully performing their job.  A review article on the “impact of cigarette use on vertebral bone metabolism and spinal fusion” in the medical journal Neurosurgery, reported that spinal fusion procedures in chronic smokers are less successful in comparison to nonsmokers.  According to the authors, Drs. Hadley and Reddy, “Chronic cigarette consumption has significant adverse effects on the human spinal column.  Multiple mechanisms  induced by tobacco use lead to less strong, less healthy, mineral deficient vertebrae with reduced bone blood supply and fewer and less bone-forming cells among chronic smokers.  Compared to nonsmokers, chronic smokers develop advanced bony degradation, are more likely to suffer from spinal column degenerative disease, and seem more susceptible to traumatic vertebral injury.”

If that doesn’t motivate you to snub out your “ciggy,” read on.

smoking-lighting-upA study out of Pittsburgh, presented at the 1997 annual meeting of the North American Spine Society, suggested that smoking may be a cause of “diminished back function.”  The study which followed 9,704 elderly women over a three-year period, found that both current and former smokers had substantially higher risks of having limited activity in areas of their daily living due to back pain versus those who had never smoked.  And the risk of having back pain confine you to a bed for a week or more was tripled when comparing current smokers to those who had never smoked.

The studies continue.

A study examining 29,424 identical twins, in which one of the siblings was a smoker and the other was not, was conducted by the Nordic Institute for Chiropractic and Clinical Biomechanics.  These researchers found a “definite link” between smoking and low back pain — a link that became convincingly stronger when the lower back pain increased in frequency and duration.

smoking-back-painA study out of Occupational Medicine found that workers employed in jobs involving heavy physical labor were much more likely to experience lower back pain if they smoked (5.53 times more).

Japanese construction workers, according to the journal Industrial Health, who smoked 20 cigarettes or more per day had significantly higher incidence of lower back pain than those who had never smoked.

Another study, this time in the journal Spine, found that persons with scoliosis tended to have an even stronger association between smoking and back pain than those smokers without scoliosis.

And it doesn’t appear that smoking discriminates in age.  A very recent study out of Spine , again, found that adolescents (grades 7-9) who smoked reported 2.4 times more back pain than their non-smoking peers.

smoking-female-exhalingWell, I’m convinced!  But as I stated before, the evidence isn’t “conclusive” that smoking per se is the sole culprit in these observations.  Skeptics are quick to point out that smokers and nonsmokers have totally different lifestyles, and that other factors could be contributing, or be the sole source, of the back problems we are seeing — a valid point, and one that certainly adheres to the scientific method; however, if you ask me, this argument sounds more like a dodging of liability.  Regardless of the exact cause, I think it is fair to say that the “smoking lifestyle,” with all of it’s various characteristics, isn’t good for your back.

Now I know that this article will be received by the community in different ways.  Some will love it — taking it as additional “ammo” to convince loved ones to quit.  Others may take it as another scare tactic to get them to quit and probably won’t read much past the headline.  And then some of the more rebellious, I’m afraid to say, may even go so far as to actually smoke it…. I hope not.  I wonder what Joe would do.


Sources used for this article:
Eriksen, Natvig, and Bruusgaard.  Smoking, heavy physical work and low back pain:  a four-year prospective study.  Occupational Medicine (London).  49(3): 155-60, 1999.
Feldman, Rossingnol, and Abenhaim.  Smoking:  a risk factor for development of low back pain in adolescents.  Spine. 24(23): 2492-6, 1999.
Hadley and Reddy.  Smoking and the human vertebral column:  a review of the impact of cigarette use on vertebral bone metabolism and spinal fusion.  Neurosurgery.  pp. 116-124.  July 1997.
Leboeuf-Yde, Kyvik, and Bruun.  Low back pain and lifestyle.  Part I:  Smoking.  Information from a population -based sample of 29,424 twins.  Spine.  23(20): 2207-13, 1998.
Scott, Goldberg, Mayo, et. al.  The association between cigarette smoking and back pain in adults.  Spine.  24(11):   1090-8. 1999.
Ueno, Hisanaga, et al.  Association between musculoskeletal pain in Japanese construction workers and job, age,   alcohol consumption, and smoking.  Industrial Health.  7(4): 449-56, 1999.
Vogt, et al.  Are smokers more likely to develop impaired back function?  Presented at the annual meeting of the     North American Spine Society.  New York, 1997 (as yet unpublished). — reported in The Back Letter. 12(12).  1997.
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