And according to multiple studies, smokers are even more likely to experience LBP and more than one time, too. It's not clear yet what the exact relationship is between smoking and LBP. It may be multifactorial, meaning more than a single factor contributes to the problem.
Perhaps there is a cluster of certain risk factors that make the difference. These could include poor nutrition, obesity, and not enough sleep or physical activity. Maybe LBP in smokers is more related to higher levels of stress, distress, and anxiety.
There may be personality traits common to people who smoke and develop LBP. Social, cultural, and economic or educational variables may make a difference. Smokers are more likely to have pain in general (not just back pain) compared to nonsmokers. So maybe there are biologic reasons some smokers develop LBP.
Some studies have shown that industrial workers who smoked and who were exposed to heavy smoking had increased rates of hospitalizations for disc disease. Most of the biologic studies of tissues have been done on animals. It isn't possible to do these kinds of studies on humans, so we don't have complete understanding of the biologic factors.
Studies are ongoing to identify specific risk factors. The hope is to prevent smoking first, then reduce risk among tobacco users.