Depending on the severity of your lumbar or cervical spinal stenosis symptoms, your doctor may recommend drugs/medications and/or therapeutic spinal injections as part of your non-surgical treatment plan. These treatments can help manage inflammation, pain and other symptoms caused by compressed nerves in your low back and/or neck.
Make sure you tell your doctor about all medications you are taking before starting any new medicine, including over-the-counter (OTC) drugs, vitamins and other supplements. This will help you and your doctor prevent possible drug interactions or adverse effects.
Furthermore, there are particular situations wherein you may need to avoid or delay undergoing a spinal injection. This usually includes patients taking a blood thinning medication, having an active infection, diabetes, and/or heart disease.
Over-the-counter Pain Medications
Over-the-counter (OTC) drugs are usually the first line of medication treatment for spinal stenosis. These medications may help alleviate pain and/or inflammation.
Medications that control pain are known as analgesics, and they are available in OTC and prescription forms. Acetaminophen (eg, Tylenol), aspirin, ibuprofen (eg, Motrin, Advil), and naproxen (eg, Aleve) are examples of OTC analgesics that your doctor may recommend for spinal stenosis.
While some analgesics only relieve pain (such as acetaminophen), others reduce pain and inflammation. Analgesics that reduce both pain and inflammation are called non-steroidal anti-inflammatory drugs, or NSAIDs. Aspirin, ibuprofen, and naproxen are examples of NSAIDs.
Prescription Drugs for Spinal Stenosis
If your spinal stenosis symptoms are not responding to OTC medication, ask your doctor if a prescription drug may provide better pain management.
Prescription-strength NSAIDs are a common prescription medication used to control spinal stenosis pain. Celecoxib (Celebrex) is an example of a prescription NSAID. Like other NSAIDs, these drugs are generally safe when used for a short time and at lower doses. Read, NSAIDs for Neck or Back Pain: Helpful or Harmful to You? for additional information.
If you have severe back or leg pain, your doctor may prescribe a short dose of oral corticosteroid medication. These types of drugs, which may also be administered via injection, contain powerful anti-inflammatory medication. Like all drugs and medications, oral steroids have side effects that you should discuss with your doctor before starting your regimen.
If you have lumbar spinal stenosis and have nerve pain in your legs that is reducing your ability to walk, your doctor may prescribe a neuropathic agent, such as gabapentin (Neurontin). Spinal stenosis in your low back can produce symptoms of lumbar radiculopathy—numbness, tingling, and burning down your legs. A neuropathic agent may reduce nerve pain and help restore function.
Another prescription pain-relieving option are narcotic analgesics, or opioids. These drugs are typically prescribed only if other medications have failed. Due to their significant side effects, including dependency, your doctor may prescribe them to be taken only for a short period of time.
Tips to Taking Your Medication Safely
Talk to your doctor about the potential red flags you should understand before you start taking a medication. Even when a drug is widely available without a prescription, that doesn’t mean it’s free of potentially serious side effects. Also, ask your doctor or pharmacist if you are unsure about any aspect of your drug regimen. Your doctor may recommend one or more medications to help manage your spinal stenosis symptoms, which means you may need to manage multiple doses and medication schedules. Using your medication(s) as directed is the safest and surest way to relieve pain associated with spinal stenosis.
If you have severe pain and symptoms related to spinal stenosis, your doctor may include epidural and/or transforaminal spinal injections as part of your treatment plan. These therapeutic spinal injections, which are also known as corticosteroid or cortisone injections, send a local anesthetic and long-acting steroid medication into the spaces around your compressed spinal nerves.
How Spinal Injections Help Reduce Symptoms
An epidural or transforaminal spinal injection works to reduce swelling and inflammation of spinal nerve roots and surrounding tissues that cause or contribute to nerve compression. When inflammation and swelling are lessened, then pain, numbness and tingling sensations are reduced, which may include symptoms that radiate into an extremity (eg, arm, leg). The outcome of an injection can, in some cases, offer diagnostic value to identify the pain generator (nerve) and its location.
Epidural or Transforaminal Spinal Injection Procedure
Either an epidural or transforaminal spinal injection typically contains a local anesthetic to help reduce procedure pain, a contrast dye to illuminate structures during intra-procedural imaging (fluoroscopy), and a steroid medication. A local anesthetic is first injected using a thin needle to numb the skin area and deeper tissues. Some patients may be offered light intravenous sedation. Fluoroscopy, similar to real-time x-ray, or ultrasound is often used during the procedure to precisely guide needle placement before and during the injection.
After a spinal injection procedure, some patients have reported their spinal stenosis symptoms were reduced a few hours after the procedure, whereas others say it took a full week to feel a difference. The longevity of symptom relief varies too with some patients reporting pain relief for several weeks or months to total and ongoing relief.
Some patients actually experience an increase in their pain level during the first few days after their injection. This is not abnormal, as the injection may temporarily increase nerve compression or irritate it. However, pain should subside within a week as the anti-inflammatory medication takes effect. Your doctor may recommend ice therapy or an over-the-counter pain medication to help you manage a spike in pain in the days immediately following your injection.
Potential Side Effects of Steroid Spinal Injections
Many patients report almost immediate relief from a therapeutic spinal injection, but steroids can have significant side effects. These are rare, but you should know and discuss the following risks with your doctor:
Post-injection Symptoms that Warrant Emergency Care
If you experience any of the following symptoms after your epidural steroid injection, seek immediate medical care:
Because of these potentially serious side effects, some patients may not be a candidate for subsequent injections. The number of injections a patient receives is determined by many factors. Be sure to talk through this issue with your doctor.
SpineUniverse Comment: Important News About Epidural Steroid Injections
While epidural steroid injections are commonly used to manage pain for several spinal disorders, including cervical and lumbar spinal stenosis, research shows that they have limitations patients should understand.
In 2014, research showed that epidural steroid injections’ ability to delay or prevent spine surgery is not as great as once thought. The study authors concluded that spinal injections lowered the need for surgery for some patients, but it was only for up to 1 year—and the injections may not have any effect on delaying or preventing surgery after that.
In 2015, another study found that injections that contained a corticosteroid and lidocaine offered no “meaningful” improvement in pain for patients with lumbar spinal stenosis compared to injections that only contained lidocaine.
These studies do not mean that epidural steroid injections are not a worthwhile treatment for spine conditions—many people have found relief with therapeutic spinal injections. This research offers you additional conversation starters with your doctor, so you can decide whether to pursue this treatment with confidence and full understanding.