Spinal Stenosis Medications

Lumbar spinal stenosis is an age-related condition that can cause your legs to feel heavy, weak, numb and/or painful when you walk or stand. According to the American Academy of Orthopaedic Surgeons, an estimated 8 - 10% of the population has this condition.

And, of all people over the age of 65 who will eventually need spine surgery, the leading diagnosis is lumbar spinal stenosis. (Acronym: LSS.)

Basically lumbar stenosis occurs when, for whatever reason (usually arthritic changes in the spine,) a reduction in the diameter of spinal canal and/or intervertebral foramen occurs. The classic symptom of LSS is neurogenic claudication, or leg cramping that is related to posture and position.

Related:  What is Neurogenic Claudication?

A 2012 review that looked at (non-surgical only) treatment for lumbar spinal stenosis with neurogenic claudication found moderate and high-quality evidence for nonoperative treatment to be lacking. This means that doctors and other clinicians are pretty much on their own when it comes to deciding the most effective treatments for LSS.

Medication is often the first line treatment for lumbar spinal stenosis.  Below is a list of the most common classes of drugs prescribed or suggested to patients with this condition.

1
Non-Steroidal Antinflammatory Drugs (NSAIDs)

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

NSAIDs, or non-steroidal anti-inflammatory drugs are usually tried first. Low doses of NSAIDs are known to give pain relief, while high doses help calm down inflammation.

But NSAIDs may have unpleasant or harmful side effects, for example, gastritis. For this reason, many doctors prescribe tramadol and/or acetaminophen instead. These drugs are known to relieve pain but they have no affect on inflammation.

More »

2
Muscle Relaxers such as Cyclobenzeprine

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

Along with NSAIDs, muscle relaxers are sometimes given as a way of increasing pain relief.

As the name implies, this class of drug promotes relaxation. Taking muscle relaxers may help you sleep and/or participate more effectively in any physical therapy program with which you may be engaged. That said, they come with a warning:  muscle relaxers may impair your ability to do certain things in a safe way, for example driving or operating heavy machinery.

More »

3
Anticonvulsants

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

If you have lateral recess stenosis, your doctor may prescribe anticonvulsants to help reduce nerve pain. Examples of drugs from this class include gabapentin and carbamazepine.  Like antidepressants, the prescription of anticonvulsants for chronic back pain is off-label.

After a few weeks of taking an anticonvulsant, possible benefits may include improved sleep, an increase in your pain threshold and/or altered pain perception. Anticonvulsants tend to be less helpful when you have acute pain, because of the time it takes before you can feel the effects.

Related:  Where is the Lateral Recess?

4
Tricyclic Antidepressants

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

Tricyclic antidepressants are approved by the FDA for depression.  But quite often doctors prescribe them for patients with chronic low back pain where nerve pain is also a factor.  (This type of prescribing is called off-label.)

The dosage for chronic back pain is typically much lower than for depression.  

Unfortunately for many people who deal with spinal stenosis pain, a number of unpleasant side effects make it difficult or impossible for elderly people to take this class of medication.  Such side effects include: Somnolence, dry mouth, dry eyes, and constipation.

Not only that, but when tricyclic antidepressants are taken with other medications, the risk arrhythmias rises.

More »

5
Opioids

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

Opioids are a narcotic medication that doctors sometimes give to patients for moderate or severe pain -  especially when the pain is accompanied by impairment of physical functioning or a quality of life decrease.

Because the risk for addiction is there when opioids are taken, especially long term, you should discuss this risk with your doctor before starting this type of medication.

If your doctor recommends opioid therapy, you may be asked to sign a medication contract that restricts you to using only1  prescribing practitioner and only 1 pharmacy, as well as no unscheduled refills, and similar things.

Opiods come with unpleasant side effects, too.  The most common is constipation.

Sources:

Ammendolia C, Stuber K, de Bruin LK, et al. Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review. Spine (Phila Pa 1976). 2012;37(10):E609-E616. doi:10.1097/BRS.0b013e318240d57d. Falkinstein, Y. MD, Advances in Management of Spinal Stenosis and Degenerative Disc Disease 2010. YouTube video. Accessed May 2015 href="https://www.youtube.com/watch?v=IHaInRbP6CU Hsiang, J., MD, PhD; Kishner, S. MD, MHA. Spinal Stenosis Medication. Medscape. Accessed May 2015. http://emedicine.medscape.com/article/1913265-medication Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane database Syst Rev. 2014;7:CD000990. doi:10.1002/14651858.CD000990.pub3. Shamie, A., N., MD. Lumbar spinal stenosis: The growing epidemic. American Academy of ORthopaedic Surgeons website. Accessed May 2015. http://www.aaos.org/news/aaosnow/may11/clinical10.asp.

Continue Reading