Spinal Stenosis Pain: Primary Management Spinal Stenosis: Primary Management
Keywords:
spinal stenosis, pain, primary managementAbstract
As spinal stenosis affects a large number of patients compromising their quality of life, pain management is of vital importance. The purpose of this study is to review the methods of pain management in patients with spinal stenosis, in hospital, in doctor’s office and at home.
A thorough search was performed at the online PUBMED database using the following keywords: “conservative treatment” OR “non-surgical treatment” OR “conservative management” OR “non-surgical management” AND “pain” AND “spinal stenosis”. The search results showed 253 posts. After checking titles and summaries, 131 articles were rejected as not relevant with pain management in spinal stenosis. Of the 122 publications that remained and were evaluated, 29 were rejected for specific reasons. Thus there were 93 studies left for the current review.
Pain management of patients with spinal stenosis is initially conservative, especially if the symptoms are simply numbness and pain. Conservative treatment includes analgesic drugs, physical therapy, steroid injections and acupuncture. However, there is little high quality evidence for the evaluation of non-operative treatment of pain due to spinal stenosis. When conservative management is inefficient, operative treatment displays satisfactory results.
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References
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2. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234.
3. Vining RD, Shannon ZK, Minkalis AL, Twist EJ. Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations. J Manipulative Physiol Ther. 2019;42(9):651-64.
4. Patel EA, Perloff MD. Radicular Pain Syndromes: Cervical, Lumbar, and Spinal Stenosis. Semin Neurol. 2018 Dec;38(6):634-9.
5. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J. 2013;13(7):734-43.
6. Costandi S, Chopko B, Mekhail M, Dews T, Mekhail N. Lumbar spinal stenosis: therapeutic options review. Pain Pract. 2015;15(1):68-81.
7. Fritz JM, Rundell SD, Dougherty P, Gentili A, Kochersberger G, Morone NE, et al. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis. Pain Med. 2016;17(3):501-10.
8. Kim K, Shin KM, Hunt CL, Wang Z, Bauer BA, Kwon O, et al. Nonsurgical integrative inpatient treatments for symptomatic lumbar spinal stenosis: a multi-arm randomized controlled pilot trial. J Pain Res. 2019;12:1103-13.
9. Overdevest GM, Moojen WA, Arts MP, Vleggeert-Lankamp CL, Jacobs WC, Peul WC. Management of lumbar spinal stenosis: a survey among Dutch spine surgeons. Acta Neurochir (Wien). 2014;156(11):2139-45.
10. Surgery may be best choice for spinal stenosis. But medication and physical therapy also can alleviate the condition without worsening it. Duke Med Health News. 2008;14(7):9-10.
11. Brøgger HA, Maribo T, Christensen R, Schiøttz-Christensen B. Comparative effectiveness and prognostic factors for outcome of surgical and non-surgical management of lumbar spinal stenosis in an elderly population: protocol for an observational study. BMJ Open. 2018;8(12):e024949.
12. Spinal stenosis. Reducing pain, improving mobility. Mayo Clin Health Lett. 2007;25(12):1-3.
13. Beyer F, Geier F, Bredow J, Oppermann J, Schmidt A, Eysel P, et al. Non-operative treatment of lumbar spinal stenosis. Technol Health Care. 2016;24(4):551-7.
14. May S, Comer C. Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy. 2013;99(1):12-20.
15. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical Versus Nonsurgical Treatment for Lumbar Spinal Stenosis. Spine (Phila Pa 1976). 2016;41(14):E857-68.
16. Shabat S, Folman Y, Leitner Y, Fredman B, Gepstein R. Failure of conservative treatment for lumbar spinal stenosis in elderly patients. Arch Gerontol Geriatr. 2007;44(3):235-41.
17. Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015;350:h1225.
18. van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain. Cochrane Database Syst Rev. 2020;4:CD013581.
19. Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016;2:CD012087.
20. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;23(1):CD000396.
21. van Tulder MW, Scholten RJ, Koes BW, Deyo RA. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2000(2):CD000396.
22. Krebs EE, Lurie JD, Fanciullo G, Tosteson TD, Blood EA, Carey TS, et al. Predictors of long-term opioid use among patients with painful lumbar spine conditions. J Pain. 2010;11(1):44-52.
23. Chung SS, Park CK, Cho KJ, Choi KH, Kim JH, Kim SB, et al. A Nationwide Retrospective Study of Opioid Management Patterns in 2,468 Patients with Spinal Pain in Korea. Asian Spine J. 2016;10(6):1122-31.
24. Adogwa O, Davison MA, Vuong V, Desai SA, Lilly DT, Moreno J, et al. Sex Differences in Opioid Use in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis Undergoing Lumbar Decompression and Fusion. Spine (Phila Pa 1976). 2019;44(13):E800-E7.
25. Davison MA, Lilly DT, Desai SA, Vuong VD, Moreno J, Bagley C, et al. Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis. Global Spine J. 2020;10(2):160-8.
26. Kha ST, Scheman J, Davin S, Benzel EC. The Impact of Preoperative Chronic Opioid Therapy in Patients Undergoing Decompression Laminectomy of the Lumbar Spine. Spine (Phila Pa 1976). 2020;45(7):438-43.
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