Drugs, Medications, and Spinal Injections for Spinal Stenosis

Unless your symptoms are very serious, your physician will probably choose to start out your treatment with medication.

You can probably agree with this: the main goal is to relieve your pain and inflammation. Pain relievers such as acetaminophen (Tylenol®) can control pain, but don't have any effect on inflammation.

If you want to fight both your pain and inflammation, you may consider non-steroidal anti-inflammatory drugs (NSAIDs). These products relieve pain and also reduce inflammation and swelling. NSAIDs include aspirin, ibuprofen (Advil™ or Motrin®), indomethacin, and naproxen.

If you have a severe case of spinal stenosis, your doctor may inject a corticosteroid medication into the spinal fluid around your spinal cord and nerve roots. This may be referred to as an epidural steroid injection. This injection targets the epidural space, which is the space surrounding the membrane that covers the spinal cord and nerve roots. Nerves travel through the epidural space to the neck, shoulders, arms, and legs. If a nerve root is inflamed in the epidural space, you can have pain.

An epidural injection puts anti-inflammatory medicine into the epidural space to decrease the inflammation of the nerve roots. The epidural injection may provide total and permanent relief—or it may reduce your pain for several months.

Corticosteroids can be especially helpful in treating pain that radiates down the back of your leg. Many people report almost immediate relief from the injections. But corticosteroids can have significant side effects. These are rare, but you should know and discuss the risks with your doctor.

Potential side effects of corticosteroids include:

• increased pain where you had the injection
• fever after you get the injection (if it's above 101º for more than 24 hours, you should let your doctor know)
• anxiety
• weight gain
• trouble sleeping
• high blood sugar (more so for people with diabetes)
• high blood pressure
• decreased ability to fight infection (more so for people who already have an infection)
• stomach ulcers
• damage to the bones in your large joints, like your hips (that's called avascular necrosis)
• cataracts

After an epidural injection, call your doctor immediately if you:

• have trouble controlling your bladder and/or bowels
• lose feeling and/or function in your arms or legs
• have a terribly painful headache when you sit up or stand, and the only way to make it feel better is to lay down.
• have extreme pain that doesn't go away when you try typical pain-fighting measures (e.g., over-the-counter medications)

Because of these potential serious side effects, most doctors limit the number of injections a patient receives. The actual number of injections a patient receives is determined by many factors. Be sure to talk through this issue with your doctor.