Spinal Stenosis Medication

Spinal stenosis can cause significant discomfort, pain, and nerve symptoms. In many cases, these symptoms disrupt patients’ daily routines, making it difficult to carry out their normal activities.

As part of a well-rounded treatment plan, spinal stenosis medications may help alleviate pain, inflammation, and muscle spasms. But, there are many considerations for taking these medications, including side effects, possible long-term complications, and interactions with other drugs. 

In this article, we’ll provide a comprehensive overview of spinal stenosis medication, including the benefits, risks, and alternative treatment options. 

What Is Spinal Stenosis and How Is It Treated?

Spinal stenosis is a condition involving the narrowing of the spinal canal. It’s treated with physical therapy, medications, lifestyle changes, and, in severe cases, surgery.

The spinal canal is a cavity that extends down the length of the spine. It consists of the hollow openings in the middle of each vertebrae, and it encloses the spinal cord. In fact, the spinal canal’s primary function is to protect the spinal cord and nearby nerves from damage.

With spinal stenosis, the spinal canal becomes abnormally narrow, leaving less space around the spinal cord and nerve roots. As the condition progresses, the canal may start to impinge on the spinal nerves, leading to radiating neurological symptoms, as well as persistent back pain. 

Spinal Stenosis Treatments

The most common spinal stenosis treatments include physical therapy, medications, lifestyle changes, and surgery.

  • Physical therapy can help with spinal stenosis by increasing core and back muscle strength. Both of these muscle groups stabilize the spine, helping to absorb impact that would otherwise affect the spine. Additionally, a PT can provide tension-relieving stretches and additional therapies (like massage, heat/cold therapy, and electromagnetic therapy) for further symptom relief. 
  • Medications can help reduce pain, inflammation, and muscle spasms from spinal stenosis. Though not a permanent treatment for this condition, medications can provide temporary pain relief and may complement other therapies, like PT.
    • Epidural steroid injections involve injecting steroid medication directly into the area of the spine affected by spinal stenosis. They can alleviate inflammation and ease pressure on the spinal nerves, allowing them to heal. However, patients can only undergo a limited number of injections per year to prevent tissue atrophy. 
  • Lifestyle changes can naturally ease spinal stenosis pain. Examples include adjusting your activities, adopting a low-impact exercise routine, eating healthily, quitting smoking, and maintaining good spinal alignment.
  • Surgery is usually only suggested for spinal stenosis if the condition causes serious disability or doesn’t respond to several months of conservative treatments. Spinal stenosis surgery involves spinal decompression and stabilization.  

What Is the First-Line Treatment for Spinal Stenosis?

The first-line treatment for spinal stenosis is physical therapy with activity adjustments. 

Physicians recommend these treatments first, before prescribing medications or considering surgery, because they’re low-risk. With physical therapy and activity modifications, patients don’t have to worry about side effects or possible complications. However, if these therapies fail to provide results, physicians typically move on to prescription pain medications and epidural steroid injections. 

What Is the Best Medication for Spinal Stenosis?

The best medication for spinal stenosis varies depending on the patient. However, non-steroidal anti-inflammatory drugs (NSAIDs) are often effective for spinal stenosis symptoms. 

NSAIDs for Spinal Stenosis

NSAIDs work by blocking cyclooxygenase, an enzyme that the body needs to produce prostaglandins. Prostaglandins are a collection of lipids that work like hormones in the body. They’re produced at areas of tissue damage in the body and affect various bodily processes, including pain and inflammation. 

By blocking cyclooxygenase, NSAIDs reduce prostaglandin production, leading to temporary relief from inflammation and pain associated with spinal stenosis. Many different NSAIDs are available, both over the counter and with a prescription. Physicians usually advise patients to begin with over-the-counter NSAIDs for spinal stenosis before considering prescription-strength medications. 

Examples of over-the-counter NSAIDs for spinal stenosis include:

  • Aspirin
  • Ibuprofen (brand names Advil and Motrin)
  • Naproxen (brand name Aleve)

Prescription-strength NSAIDs can be used when over-the-counter options don’t provide spinal stenosis symptom relief. These drugs may involve higher dosages of the medications listed above, as well as celecoxib (brand name Celebrex). Celecoxib is only available with a prescription, but has been found to cause fewer gastrointestinal side effects than other prescription-strength NSAIDs. 

NSAID Safety

When prescribed by a qualified, licensed physician and used as advised, NSAIDs can be safely used to manage spinal stenosis pain. However, this type of medication should only be taken for a limited period and at the lowest effective dose. 

Possible side effects of NSAIDs include:

  • Bloating
  • Gas
  • Stomach pain
  • Heartburn
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea 
  • Dizziness or lightheadedness
  • Trouble concentrating
  • Mild headache 

Gastrointestinal side effects are the most common with NSAIDs. Taking these medications with a meal, milk, or even antacids may help lower your risk of experiencing these symptoms. However, if side effects persist, reach out to your physician for guidance. 

Other Medications for Spinal Stenosis

While NSAIDs are the most common medication used for spinal stenosis, there are other options available. These include:

  • Analgesics (also known as painkillers) alleviate pain but don’t impact inflammation. Examples include acetaminophen (brand name Tylenol) and tramadol. 
  • Muscle relaxants can be used to treat the muscle spasms that some patients experience with spinal stenosis. Examples include cyclobenzaprine, baclofen, and methocarbamol. 
  • Corticosteroids curb inflammation in the spinal canal, leading to reduced nerve compression and pain. The medications that may be used in epidural steroid injections include triamcinolone, methylprednisolone, dexamethasone, and hydrocortisone. 
  • Anticonvulsants can help alleviate neuropathic radicular pain and lower back pain from spinal stenosis. Examples include gabapentin and carbamazepine. 
  • Antidepressants can be used, in some cases, to help treat spinal stenosis. This type of medication may work by boosting neurotransmitters in the spinal cord, leading to decreased pain signals. Antidepressants that may be used for spinal stenosis include amitriptyline, clomipramine, and nortriptyline. 

Can Steroids Help Spinal Stenosis?

Steroids can help spinal stenosis by reducing inflammation in the spinal canal, helping to decrease spinal nerve compression. 

While steroids may help with spinal stenosis pain management in some individuals, there are risks and drawbacks to consider.

For one, spinal stenosis is a degenerative condition – it’s not caused by inflammation. Inflammation results from pressure on the spinal nerves. So, while steroids can help temporarily reduce its symptoms, they don’t address the root of the condition.

Additionally, epidural steroid injections pose some serious risks, including nerve damage and paralysis. These severe complications are rare, but worth considering. Less severe side effects of steroid injections include:

  • Steroid flushing, which includes face and chest flushing for several days after the injection
  • Anxiety
  • Disrupted sleep
  • Water retention
  • Menstrual changes

Also, patients shouldn’t receive more than 3 steroid injections annually to prevent tissue atrophy, with at least 6 weeks between injections. 

What Muscle Relaxer Is Used for Spinal Stenosis?

The muscle relaxers that are used for spinal stenosis include:

  • Cyclobenzaprine (brand name Flexeril)
  • Carisoprodol (brand name Soma)
  • Baclofen (brand names Lioresal and Lyflex)
  • Methocarbamol (brand name Robaxin)
  • Tizanidine (brand name Zanaflex)

Muscle relaxants hinder nerve signals traveling between the brain and spinal cord, leading to relief from muscle spasms. These medications can also help reduce many of the neurological symptoms associated with spinal stenosis, including numbness, tingling, and stabbing, shooting, or radiating pain. 

What Is the Most Successful Treatment for Spinal Stenosis in L4-L5?

The most successful treatment for spinal stenosis in L4-L5 can vary depending on the patient. However, in cases that don’t respond to conservative treatment, minimally invasive spinal decompression with non-fusion stabilization is often the best option. 

Minimally invasive spinal decompression surgery involves removing a small amount of tissue to create more space in the spinal canal. Depending on the exact procedure, the surgeon may remove part of the lamina, intervertebral disc, or thickened ligament. This process also alleviates pressure on the affected spinal nerves. 

Minimally Invasive Spinal Decompression for L4-L5 Spinal Stenosis

Compared to conventional spinal decompression surgery, minimally invasive procedures are safer, involve less postoperative pain, and lessen recovery times. They involve a smaller incision and less disruption to the surrounding tissues. Minimally invasive spinal decompression may involve the use of an endoscopic camera, allowing the surgeon to view the spinal canal through a very small incision. 

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After removing tissue from the spinal canal, the surgeon typically must stabilize the spine to prevent future injuries. In past eras, the only option of stabilization was spinal fusion, which permanently joins two or more vertebrae using a bone graft. Now, spinal stenosis patients can opt for non-fusion options, like the TOPS System. 

The TOPS System for L4-L5 Spinal Stenosis

The TOPS System is a non-fusion spinal implant that’s been approved by the FDA for moderate to severe lumbar spinal stenosis. It’s also earned a superiority-to-fusion claim from the FDA, as it stabilizes the spine while preserving motion in all directions. This prevents reduced mobility, shortens recovery times, and reduces the risk of degeneration to surrounding vertebrae. 

If you’re experiencing symptoms of spinal stenosis, schedule an appointment with a qualified physician to learn more about spinal stenosis medications, along with other available treatments.