The effects of nicotine and smoking on spinal pain

The effects of nicotine and smoking on spinal pain are well understood by science, but not by the general public. Cigarette smoking is well known and documented to be detrimental to ones health and is described as “the leading cause of preventable death in the EU, responsible for nearly 700,000 deaths every year”1. There is also estimated to be another 13 million people in the EU living with poor health and chronic diseases as a result of smoking2.


With the increasing popularity of e-cigarettes and e-liquid smoking devices, I thought it be poignant to discuss, not smoking in general but the effects nicotine have on the spine. It is not important which nicotine delivery system is preferred; it is the nicotine itself we are interested in here.


Nicotine levels greater than 25nmol/L for longer than 7-days demonstrate a dose-dependent reduction in DNA and cell proliferation within the intervertebral discs3-7). Nicotine levels in bodily fluids of smokers/regular users have been found to fluctuate between 50nmol/L – 300nmol/L8.


Nicotine also has a negative affect on bone density by causing a reduction in DNA content of osetoblasts (the cells that create new bone) resulting in cell death4. This then contributes to the development of osteopenia (thin/weakened bones) and osteoporosis (brittle bones). While osteoporosis is seen as a common problem in postmenopausal women9, nicotine exposure contributes to the loss of bone density, thereby accelerating the process.


This has further consequences on your bone health. Nicotine has also been demonstrated to disrupt bone healing10-14. This has implications for simple things such as bone healing following fracture, but also more complex such as bone healing following surgery or during physical therapy such as traction.

In a study performed by Akmal et al3, they found that nicotine receptors are found within the intervertebral discs of the human spine also. They found that nicotine exposure to the cells of the intervertebral discs to produce a different type of collagen fiber. The collagen fibers change from type II to type I, which is a more fibrous type of collagen3. This also shows not only the inhibition of type II collagen synthesis, but also the inappropriate production of type I collagen. As a result, the discs become stiff, which disrupts load dissipation function of the cells15. This same process occurs during the degeneration process of discs seen with aging16, 17. Therefore, nicotine exposure induces a similar degenerative process of the discs, leading to accelerated wear and tear. If then, back pain is being caused by degenerative disc disease, then smoking will increase these symptoms, leading to increased back pain.

Regardless of the delivery system, be it gum, spray, cigarette, cigar, e-cigarette or e-liquid they all contain nicotine. It is important that we understand the effects all drugs have on our bodies. The body is capable of withstanding the effects of toxins within our environment, some better than others. But even the drugs and toxins that have a perceived small impact on our bodies, their effects can be cumulative, gradually increasing their damaging effects over time.

If this blog has got you thinking and you would like your spinal health assessed, contact us directly and we can make an appointment with our Chiropractor. Alternatively, have a look at Spriggs Nutrition has lots of great information for nutritional support for improving your bone and overall health.



  1. European Commission. Attitudes of Europeans Towards Tobacco and Electronic Cigarettes. 2015. http://ec. ebs_429_en.pdf. Accessed June 13, 2016.
  2. Jayes L, Haslam PL, Gratziou CG, Powell P, Britton J, Vardavas C, Jomenez-Ruiz C and Leonardi-Bee J 2016. SmokeHaz: Systemic reviews and meta-analysis of the effects of smoking on respiratory health. Chest 150(1): 164-179
  3. Akmal M, Kesani A, Anand B, Singh A, Wiseman M and Goodship A 2004. Effect of nicotine on spinal disc cells: A cellular mechanism for disc degeneration. Spine 29(5): 568-575
  4. Fang MA, Frost PJ, Had-Klein A, et al 1991. Effects of nicotine on cellular function in UMR 106–01 osteoblast-like cells. Bone (12):283–286.
  5. Ramp WK, Lenz LG, Galvin RJ 1991. Nicotine inhibits collagen synthesis and alkaline phosphatase activity, but stimulates DNA synthesis in osteoblast- like cells. J Exp Biol Med; 36–43.
  6. Yuhara S, Kasagi S, Inoue A, et al 1999. Effects of nicotine on cultured cells suggest that it can influence the formation and resorption of bone. Eur J Pharm 
  7. Slatkin TA, Orband-Miller L, Queen KL, et al 1986. Effects of prenatal nicotine exposure on biochemical development of rat brain regions: Maternal drug infusions via osmotic minipumps. J Pharm Exp Ther 240:602– 611.
  8. Bosuizen HC, Verbeek JH, Broersen JP, et al 1993. Do smokers get more back- pain? Spine 18:35– 40.
  9. Zhou Q, Zhu L, Zhang D, Li N, Li Q, Dai P, Mao Y, Li X, Ma J and Huang S 2016. Oxidative stress-related biomarkers in postmenopausal osteoporosis: A systemic review and meta-analysis. Disease Markers 2016: 1-12
  10. Theiss SM, Boden SD, Hair G, et al. The effect of nicotine on gene expression during spinal fusion. Spine 2000;25:2588–2594.
  11. Hollinger JO, Schmitt JM, Hwang K, et al. Impact of nicotine on bone healing. J Biomed Mat Res 1999;46:438–439.
  12. Broulik PD, Jarab J. The effect of chronic administration of nicotine on bone mineral content in mice. Horm Metab 1993;25:219 –221.
  13. Silcox DH, Boden SD, Schimandle JH, et al. Reversing the inhibitory effect of nicotine on spinal fusion using an osteoinductive proteind extract. Spine 
  14. Wing KJ, Fisher CG, O’Connell JX, et al. Stopping nicotine exposure before surgery: The effect on spinal fusion in a rabbit model. Spine 2000;25:30–34.
  15. Iatridis JC, Weidenbaum M, Setton LA 1996. Is the nucleus pulposis a solid or a fluid? Mechanical behaviour of the nucleus pulposis of the human intervertebral disc. Spine 21:1174–1184.
  16. Buckwalter JA, Einhorn TA, Simon SR 2000. Orthopaedic Basic Science. Biology and biomechanics of the musculoskeletal system. Am Acad Orthop Surg.
  17. Buckwalter J A 1995. Aging and degeneration of the human intervertebral disc. Spine 20:1307–1314.
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