Do you smoke cigarettes or chew tobacco? When you have fibromyalgia, tobacco use may have even greater health risks than you thought. Multiple studies have shown that tobacco use is associated with worse fibromyalgia symptoms. Smoking may also be a risk factor for developing this condition.

At the same time, people with fibromyalgia often claim that smoking helps them cope with fibromyalgia pain. What do the studies tell us, and how can you use this information to improve your health?

A woman smoking a cigarette indoors
Sabina Dimitriu / Getty Images

Understanding Fibromyalgia

Fibromyalgia is a frustrating condition characterized by widespread musculoskeletal pain, tenderness, and fatigue. In addition to physical symptoms, fibromyalgia may affect mood, stress levels, and behaviors such as smoking. Unlike arthritis, fibromyalgia is not characterized by inflammation, and the condition is sometimes referred to as a type of soft tissue rheumatism.

While fibromyalgia does not involve inflammation, studies have found changes in some hormones, neurotransmitters in the brain, and an increase in substance P (pain factor) in some people with the condition. Since tobacco can also influence neurotransmitters as well as have hormonal influences, the possibility that smoking may affect the course of the disease is important to review.

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How Smoking Affects Fibromyalgia Symptoms

At this time we now have several studies that suggest smoking can worsen the symptoms of fibromyalgia. We will review some of the findings, and then talk about the underlying mechanisms that may be responsible. Overall, however, the studies have been mixed in their findings.

  • A 2009 Mayo Clinic study found that tobacco use in people with fibromyalgia was linked to greater pain intensity, higher scores on the Fibromyalgia Impact Questionnaire, fewer good days overall, and more missed work.
  • Another 2009 study found that some symptoms of fibromyalgia were worse in people who smoked including the severity of chronic widespread pain, the frequency of non-restorative sleep, the frequency of paresthesias (odd nerve sensations), and the presence of anxiety and depression. Of note was that a fourth of these people were “re-smokers,” people who had quit smoking and began smoking again, apparently to cope with their symptoms. When compared with people with rheumatoid arthritis, those with fibromyalgia were more likely to smoke. In addition, the education levels were higher in smokers with fibromyalgia than non-smokers in this study. Clearly, it’s not simply a lack of education that’s at work here.
  • A 2011 study found that people with fibromyalgia who smoked had more tender points and were more likely to be depressed (women only).

Smoking as a Possible Cause of Fibromyalgia

Most of the studies to date look at the effect of smoking on fibromyalgia symptoms. What do we know about smoking as a possible risk factor for the development of fibromyalgia in the first place? A 2010 study asked this question, though it looked only at women. Smoking did appear to be a risk factor for the development of fibromyalgia in that those who smoked were 2.37 times more likely to develop fibromyalgia than those who did not smoke.

When looking at studies like this it’s important to point out the difference between correlation and causation. Because something is related in this way does not mean it is a cause. A commonly cited example is that of eating ice cream and drowning. Those who eat ice cream may be more likely to drown, but the commonality is that both activities usually occur in the summer. Ice cream doesn’t cause drowning. Further studies will need to be done to evaluate whether smoking is clearly a risk factor for fibromyalgia. In this study, the development of fibromyalgia was also associated with having a history of hyperemesis gravidarum (severe morning sickness in pregnancy).

Smoking, Fibromyalgia, and Functional Impairments

In addition to a worsening of pain, those who smoke and also have fibromyalgia appear to have greater functional impairments, in other words, a reduced ability to perform their activities of daily living and work.

Pain, Smoking, and Fibromyalgia

How could smoking have an effect on pain in people with fibromyalgia? We know that smoking has an effect on biochemical pathways in the central nervous system and that fibromyalgia is a condition characterized by central nervous system dysfunction. Researchers have proposed different theories as to this link.

We know that smoking stimulates nicotinic receptors in the brain and inhibits a chemical known as leptin. Together, this can work to deregulate the way the brain and endocrine system responds to pain. Some believe that the deregulation of the balance between leptin and another chemical known as neuropeptide Y could be an important mechanism for pain in fibromyalgia. Others propose that low levels of IGF1 could be responsible as pain may improve with smoking cessation. There is clearly much more research to be done, both to better understand the relationship between smoking and fibromyalgia and perhaps, through this understanding, learn of better ways to treat the condition.

As noted earlier (and below), some people re-start smoking after a diagnosis or feel that smoking helps them cope with the condition. We do know that the prevalence of smoking in people with chronic pain hasn’t declined like it has in the general population, suggesting that smoking may affect biochemical pathways in more than one way.

Patient Perception of the Effect of Smoking on Fibromyalgia

We’ve looked at what the limited studies to date have shown about smoking and fibromyalgia, but what do those who are living with fibromyalgia think? A 2016 study addressed the question of how people living with fibromyalgia believe smoking affects their disease.

Most people did not feel that smoking had an effect on their physical symptoms (such as pain) but felt that smoking helped them cope with the disease. The majority of the people in the study justified their smoking by saying it helped them cope with pain (69 percent), was a distraction (83 percent), helped them relax (77 percent), reduced emotional distress and frustration (83 percent), or helped with sadness (54 percent).

When questioned specifically about the effect of smoking on their pain, those who were only mildly or moderately addicted to tobacco did not notice much difference in pain, depression, or anxiety. In those who were moderate to severely addicted, however, many felt that smoking helped with their pain.

These study findings are important to address. We know smoking is not healthy, and studies above suggest it worsens pain with fibromyalgia. But those who feel that smoking is helping their pain will be less inclined to want to quit. Combining this with the knowledge that those with chronic pain, in general, are less likely to kick the habit than those without chronic pain, indicates that the topic of this article needs further study.

Quitting Smoking

Studies to date have found that smoking may worsen fibromyalgia pain, but many people with fibromyalgia believe smoking helps them cope. It’s not a lack of education of the dangers of smoking. Perhaps the exploration of healthier coping mechanisms is of greatest importance for helping smokers with the disease better cope so that they can adequately address smoking cessation.

Quitting smoking is not easy. Reviewing the importance of smoking cessation is a good start, along with achieving the right mindset. Learning about coping strategies to reduce stress is important for anyone who considers quitting, but especially key with fibromyalgia. With coping strategies in place, check out our quit smoking toolbox to learn how to prepare your self for successful quitting, and hopefully, less pain.

Bottom Line

We are just beginning to learn about the possible role of smoking as a habit that worsens fibromyalgia pain and might be a risk factor for the development of the disease in the first place. Studies we have link smoking with more pain and reduced physical functioning, and there are biochemical mechanisms that may describe some of the relationship.

At the same time, many people with fibromyalgia and chronic pain in general use smoking as a coping mechanism. Given the importance of smoking cessation for so many reasons, making sure you have excellent coping strategies in place will likely help make your next “quit” a successful quit.


By Adrienne Dellwo
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.

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