New research shows female smokers experience more severe musculoskeletal pain than nonsmokers do.

More than 6,000 Kentucky women over the age of 18 were surveyed by investigators from the University of Kentucky on their smoking habits and symptoms of chronic pain. Syndromes included in the analysis were fibromyalgia, sciatica, chronic neck pain, chronic back pain, joint pain, chronic head pain, nerve problems, and pain all over the body.

Results showed that women who smoke, or who were former smokers, had a greater chance of reporting at least one chronic pain syndrome in comparison to nonsmokers. Former smokers showed a 20 percent increase, occasional smokers showed a 68 percent increase, and in daily smokers the odds more than doubled (104 percent).

In addition, daily smoking was associated more strongly with chronic pain than older age, lower educational attainment, obesity, or living in an Appalachian county.

There’s a definite connection, but the direction of it is uncertain, says Dr. David Mannino, a pulmonary physician in the UK College of Public Health and co-author of the study.

“This study shows a strong relationship between heavy smoking and chronic pain in women,” Mannino said. “But what is the direction of this association? Does smoking cause more chronic pain, or do more women take up smoking as a coping mechanism for experiencing chronic pain?”

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