As if there aren’t already enough reasons to stop smoking, chronic back pain sufferers – and those who want to avoid chronic back pain (and who wouldn’t?) – may have one more. Smoking is associated with an increased incidence of chronic pain, particularly back pain, according to research to date.

The evidence is strong enough that “I think we can, with a fairly high degree of certainty, link smoking to multiple negative outcomes,” says Dr. Crawford Barnett, a pain management specialist at Cleveland Clinic Hillcrest Hospital in Cleveland.

What’s more, smoking presents a double whammy. That’s because research also indicates it’s associated with poorer treatment outcomes and higher risk for patients who undergo procedures, whether it’s having an implantable device like a neurostimulator put in to block the sensation of pain, or having a spine operation. “Many surgeons will not do elective spine surgery if the patient’s still smoking,” Barnett says.

Besides raising the risk of issues like infection during a procedure, smoking impairs the body’s ability to heal, he says. “Because again when you heal, you need oxygenated blood and if I’m restricting that, you’re just not going to heal as well,” Barnett explains. “You want the wound to heal, you want everything to solidify, you don’t want wound breakdown, you don’t want bone grafts not to take. So it makes a huge impact on the ultimate outcome of the patient.”

Other research suggests smoking has an impact on how a person experiences pain at a brain, or neurological, level.

Generally speaking, experts say, more research is still needed to understand exactly why smoking might contribute to chronic pain. But where there are already countless reasons to kick the habit, this is another, clinicians say, that shouldn’t be ignored. And it’s something patients should talk to their health providers about as part of a comprehensive approach to reduce – or prevent – persistent back pain.