How is spinal stenosis treated?

The preferred treatment for cases of persistent back pain from spinal stenosis is a combination of physical therapy, prescribed exercise, and medications for chronic pain. In some cases, you may benefit from steroid injections for temporary pain relief. Only if you have persistent pain, or if your pain does not respond to these efforts, will your physician consider surgery to relieve the pressure on the affected nerves or on your spinal cord.

Nonsteroidal anti-inflammatory analgesics for chronic pain in spinal stenosis

The most common treatment for chronic pain in spinal stenosis is nonsteroidal anti-inflammatory drugs (NSAIDs). These include:

  • Celecoxib (Celebrex)
  • Diclofenac (Voltaren)
  • Ibuprofen (Advil, Motrin)
  • Indomethacin (Indocin, Indocin SR)
  • Naproxen (Aleve, Naprosyn)
  • Oxaprozin (Daypro)

Other pain medications that may be helpful:

  • Acetaminophen (Tylenol)
  • Tramadol (Ultram) a narcotic-like pain reliever

Nerve pain medications

Some medications focus specifically on nerve pain and include:

  • Duloxetine (Cymbalta)
  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)

Anticonvulsants to control pain in spinal stenosis

Two anticonvulsant agents in particular have been found to help with pain control in spinal stenosis by decreasing abnormal electrical activity. These include:

  • Carbamazepine (Carbatrol, Equetro, Tegretol)
  • Phenytoin (Dilantin, Phenytek, Di-Phen)

Tricyclic antidepressants for chronic pain in spinal stenosis

A tricyclic antidepressant can be helpful in pain management for spinal stenosis, in particular amitriptyline (Elavil, Endep, Vanatrip).

Steroid injections

In some cases, you may benefit from steroid injections for temporary pain relief. These include:

  • Cortisone (Celestone, Kenalog)
  • Methylprednisolone acetate (Depo-Medrol, Medrol)

Surgical Treatments

In some cases you may need surgery to relieve spinal stenosis, particularly if a disc fragment is lodged in your spinal canal and is pressing on a nerve, which can cause significant loss of function.

What you can do to improve your spinal stenosis

In addition to using medications to reduce chronic back pain, you can also maximize your mobility and minimize stiffness by:

  • Attending physical therapy as prescribed by your medical practitioner
  • Consulting a chiropractor for pain relief from lumbar stenosis (warn your practitioner if you have osteoporosis or herniated disc)
  • Exercising and remaining physically active
  • Practicing exercises and lifestyle changes as directed by your medical practitioner or physical therapist

Complementary treatments

Some complementary treatments may help some people to better deal with spinal stenosis and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture
  • Biofeedback
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
  • Yoga

What are the potential complications of spinal stenosis?

Complications of untreated or poorly controlled spinal stenosis can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of spinal stenosis include:

  • Adverse effects of treatments
  • Dependence on pain medications
  • Diminished overall quality of life
  • Disability
  • Immobility
  • Injury to the legs or feet due to loss of sensation
  • Permanent loss of sensation
  • Permanent nerve damage or disability
  • Permanent or chronic pain
  • Progression of symptoms
  • Worsening of infections due to loss of sensation

    References:

    1. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
    2. Lumbar spinal stenosis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00329
    3. Spinal stenosis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001477/
    4. Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med 2008; 358:818.
    5. Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006; 443:198.

    INTRODUCTION

    What is spinal stenosis?

    Spinal stenosis is a condition in which the spinal cord is compressed because of a narrowing of either the spinal canal within the spinal column, or the openings through which nerves extend away from the spinal column.

    The spinal column refers to the column created by your vertebrae. This column is hollow at its core, creating a spinal canal to house and protect the spinal cord, w... Read more about spinal stenosisintroduction

    SYMPTOMS

    What are the symptoms of spinal stenosis?

    Symptoms of spinal stenosis may develop gradually and increase over time. Sometimes they occur on only one side of the body, depending on which nerves are being compressed or stressed.

    Common symptoms of spinal stenosis

    You may experience spinal stenosis symptoms constantly or on and off during the day. At times any of these symptoms can be severe:

    CAUSES

    What causes spinal stenosis?

    Spinal stenosis can be caused by arthritis, as well as degeneration of the bones and discs through the aging process. It can also be caused by a congenital defect (present at birth), by injury, chronic infection or inflammation, spinal tumors, or bone diseases. In some cases, any kind of surgery on the spine can also lead to spinal stenosis.

    Causes of spinal stenosis

    Th... Read more about spinal stenosiscauses

    Medical Reviewer: William C. Lloyd III, MD, FACS Last Annual Review Date: Sep 30, 2013 Copyright: © Copyright 2014 Health Grades, Inc. All rights reserved. May not be reproduced or reprinted without permission from Health Grades, Inc. Use of this information is governed by the HealthGrades User Agreement.

    This Article is Filed Under: Brain and Nerves