Previous studies have shown a relationship between cigarette use and pain but never in the setting of traumatic spinal cord injury (TSCI). Therefore, the objectives of this study were to (1) determine whether smokers with TSCI experience increased pain compared with nonsmokers with TSCI and (2) determine whether smokers with TSCI experience worse functional outcomes than nonsmokers with TSCI. A retrospective analysis of the National Spinal Cord Injury Statistical Center database was performed. Pain severity, interference, and functional outcomes were compared between 514 nonsmokers and 124 smokers with American Spinal Injury Association (ASIA) C/D TSCI. Smokers reported higher scores for pain severity and interference compared with nonsmokers. These findings were significant on multivariable analysis. Smokers also reported higher rates of job loss compared with nonsmokers, but this finding was not significant on multivariable analysis. Smoking may be an independent risk factor for increased pain severity and interference in the setting of TSCI. (Journal of Surgical Orthopaedic Advances 33(2):103-107, 2024).