If you find yourself lighting a cigarette when you’re in pain, you’re not alone. Many people smoke to cope with chronic pain. But here’s the kicker: Research shows that tobacco use overall – both smoking and chewing tobacco – can actually trigger pain. It also can make pain medication less effective.

The situation is complicated for smokers. More than half of chronic pain sufferers who seek pain management therapies smoke.

Tobacco use plays an active role in a wide variety of pain types, says pain management specialist Benjamin Abraham, MD.

In many cases, if you stop smoking, you can reverse the impact. In other cases, the damage is permanent.

The many pains of smoking

Tobacco use affects different areas of the body and the body’s systems in different ways.

Circulatory system: The nicotine in cigarettes and chewing tobacco decreases circulation, a condition also called peripheral artery disease (PAD).

The condition leads to atherosclerosis, a stiffening of the arterial walls that contributes to coronary artery disease. PAD also starves the heart muscle of needed oxygen and causes chest pain, called angina.

Lower back: Research shows that current and former smokers are 2.7 times more likely to have pain in the lower back than people who have never smoked. This link is strongest among adolescents, Dr. Abraham says.

Several factors contribute to the link between smoking and back pain:

• Constricted blood vessels make it harder for necessary nutrients to reach the intervertebral discs responsible for spinal movement.
• Decreased blood supply can cause degenerative lesions on these discs.
• Smoking increases the risk for osteoporosis, which can cause fractures and deformities in the lower spine.

Joint pain: Smoking also contributes to joint pain linked to other conditions, such as rheumatoid arthritis (RA), Dr. Abraham says.

Recent studies label smoking as one of the biggest contributing environmental risk factors for developing RA.

Male smokers are twice as likely to develop RA, and female smokers are 1.27 times as likely as non-smokers. Smokers who have a genetic risk for RA are four times as likely to develop the condition.

Central nervous system: Smoking increases the level of pro-inflammatory cytokines floating in the blood stream.

Cytokines trigger the central nervous system, amplifying existing pain from the very first cigarette, Dr. Abraham says. Consequently, smokers require greater amounts of both over-the-counter and narcotic medications to control pain.

Menstrual cycle: According to a study in the British Medical Journal, women who begin smoking by age 15 are 50 percent more likely than non-smokers to have cramps that last two or more days during their period.

Tooth pain: Research shows smokers face a 30 percent increase in the risk of tooth pain. Researchers suspect the pain develops because tobacco reduces saliva and also leads to progressive tooth decay and poor wound healing.

Headache: Smokers are also 1.5 times more likely to get headaches than people who have never smoked.

Cluster headaches – severe headaches that last between 15 minutes and three hours – are common among smokers. Eighty percent to 90 percent of cluster headache sufferers have a significant history of smoking tobacco, Dr. Abraham says.

Can the painful damage be reversed?

The medical industry currently doesn’t know if there is any safe level of cigarette use, Dr. Abraham says. Much depends on gender, age and other contributing factors of disease, but some research suggests that as few as 10 cigarettes can induce an increase in general pain, slower healing, worse surgical outcomes, and more pain after surgery.

Tobacco-induced damage to structures linked to long-term pain, such as degenerative disc disease, does not heal on its own. However, in some areas, including the circulatory system, smoking cessation can reverse tobacco’s effect on pain, Dr. Abraham says.