Spinal stenosis is a condition where the spaces within the spine narrow, causing considerable pain. This article looks into various available painkillers that aim to ease the pain associated with this condition. Whether you are using non-steroidal anti-inflammatory drugs (NSAIDs) or potent opioids, this guide can help you understand their effectiveness and safety.
Doctors use different medications, such as NSAIDs, acetaminophen, muscle relaxers, and opioids, to help people with spinal stenosis pain, even though these medications aren't FDA approved for this purpose.
Some antidepressant medications may help lessen the pain from spinal stenosis and have support from experts to treat this condition.
Physical therapy, devices, and surgery are preferred to medications to address the root cause of spinal stenosis pain.
Overall, it is essential to talk with your doctor or pharmacist before using any painkiller to understand the best way to use them and avoid harm.
What is spinal stenosis?
Spinal stenosis develops when the space inside the spine gets smaller, putting pressure on the nerves there. This can cause pain, tingling, or weakness in your back, neck, legs, or arms.
Spinal stenosis usually occurs in people over 50 because of changes in the aging spine or as the result of arthritis. Yet, young people can have it, too, especially if they were born with a narrow spine or become injured. The symptoms can vary depending on which part of the spine is affected.
What painkillers are available in the U.S. for spinal stenosis?
Although the main treatments for spinal stenosis are physical therapy or surgery, doctors may use a limited number of medications to help treat your symptoms. The following classes of medications are typically used:
- Muscle relaxants
Unfortunately, these medications do not treat the underlying problem of spinal stenosis, and over time, you may need to consider surgery or other methods to relieve pain.
Are painkillers proven to be safe and effective in spinal stenosis?
Overall, no FDA-approved painkillers are specifically made to treat spinal stenosis, meaning they are used off-label to treat this type of pain. Doctors can prescribe medications off-label to treat spinal stenosis pain using their professional judgment and experience with accepted treatment guidelines.
Experts debate the usefulness of painkillers to treat spinal stenosis pain because there are not enough well-designed studies to prove they are effective, especially over the long term.
Safe use of these medications will vary depending on the type of pain, individual age, health conditions, and the length of use. Before using any painkiller, getting advice from your pharmacist or doctor, even if you plan on short-term use, is best.
Let's look deeper at the types of painkillers used to treat spinal stenosis pain and safe ways to use them.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce inflammation caused by arthritis or age changes in the spine. They help lessen swelling by blocking a substance called cyclooxygenase from creating toxins that cause soreness in places like joints and tissues.
Common NSAIDs include:
Some painkillers, such as ibuprofen and naproxen, can be found over the counter (OTC) and are best for occasional or short-term use. This is because long-term use of any NSAID carries a risk of causing high blood pressure, bleeding, and kidney, liver, or heart damage.
If your doctor decides it is OK for you to use OTC or prescription NSAIDs over the long term, it is recommended to schedule frequent checks of:
- Lab tests for blood loss
- Lab tests for kidney or liver problems
The FDA has a medication guide for warnings about NSAID use that is important to read before using these medications. Generally, after reviewing available evidence, researchers say that NSAIDs may not be effective for spinal stenosis pain.
Acetaminophen (Tylenol, APAP, paracetamol) is an analgesic (pain reliever) that inhibits the action of cyclooxygenase, just as the NSAID class does. Because acetaminophen works in the brain and spine, it only blocks pain signals and has no anti-inflammatory actions. This makes it a safer option for people who cannot take NSAIDs due to bleeding and heart and kidney problems.
Even though acetaminophen is available OTC, it is best for a doctor to monitor your labs during long-term use because it may cause harm to your liver. Acetaminophen and alcohol can cause permanent liver damage, so use caution to avoid combining them.
Again, research is unclear about the effectiveness of acetaminophen for spinal stenosis pain.
Corticosteroids, or steroids, can be administered orally or via spinal injections. They temporarily block swelling and pain caused by arthritis or tissue damage.
It's important to note that these steroids aren't the same as the ones used by people to build muscle. Instead, corticosteroids are manufactured medications designed to act like the steroids our bodies naturally produce in our adrenal glands.
Common prescription steroids include:
Steroids are best for short-term use because they can weaken your immune system and cause brittle bones.
Scientists who summed up previous research about steroids to treat spinal stenosis believe they may not help in this condition. Also, the FDA has published warnings on the risks of receiving spinal injections, including vision loss, paralysis, or death. If your doctor does decide to give you spinal injections, experts say not to have more than 3 injections per year.
Anticonvulsants, or seizure medications, work by blocking damaged nerve signals to the brain. You may take this medication for long-term under the care of your doctor.
If you have to stop taking a seizure medication, it's important to wean off slowly to avoid having seizures that happen when you suddenly stop the medication. Always follow the advice of your doctor if you need to stop a medication.
Seizure medications used for spinal stenosis pain include:
Both medications have the potential for misuse, overdose, and death, particularly in combination with opioids. This means people who have had problems with their mental health or have used substances in the wrong way before might be more likely to use these medications in a harmful way.
It's uncertain if using seizure medications to treat spinal stenosis pain is worth the risks, as there's not enough research on their effectiveness.
The latest recommendations from spinal stenosis treatment experts suggest that certain antidepressants may effectively treat spinal stenosis pain. These include:
Antidepressants help increase the neurotransmitters serotonin and noradrenaline, which improve our feelings of well-being. These substances can reduce pain signals in the spine but take time to work, sometimes up to several weeks.
However, the FDA has determined that antidepressants have risks, including:
- High blood pressure
- Suicidal thoughts and actions
If you have to discontinue an antidepressant for pain, your doctor will need to decrease your medication slowly. This helps prevent sensitivity to pain and withdrawal symptoms.
Muscle relaxants are medications that help to reduce muscle spasm pain by slowing down the signals between your brain and spinal cord. A few commonly prescribed muscle relaxers are:
While they help reduce muscle spasms and pain, they might also cause other problems. These include:
- Inability to think clearly
These medications also carry an increased risk of misuse, overdose, and death, especially in combination with opioids. For these reasons, experts do not recommend muscle relaxers as routine treatment for spinal stenosis.
Prescription opioids, the strongest painkillers available, can alleviate intense pain caused by a spine injury or major surgery when used correctly.
The CDC recommends this class of medication for short-term use of about 3–7 days. Long-term use of opioids is intended for instances of cancer pain or end-of-life pain.
Doctors may commonly prescribe:
If your doctor decides to prescribe opioids for chronic pain, it's best to stay at the lowest dose possible and avoid adding medications that increase the risk of overdose and death. Examples of medication classes that increase the risk are:
- Benzodiazepines (anxiety medications such as alprazolam and lorazepam)
- Muscle relaxers
You may also benefit from seeing a pain management specialist who will design a complete plan to treat your pain and keep you safe.
This plan will include how to lock and store your medications safely. It is also best to have naloxone, an opioid reversal medication, on hand in case of an overdose. Everyone in your household will need to understand where you store it and how to use it.
Ultimately, it is important to remember that studies point out these medications are most likely not suitable for treating chronic pain. Using them for a long time can be dangerous, as they have the potential for misuse, overdose, and death.
The final analysis
You might be exploring options to relieve pain from spinal stenosis, a condition where your spine's space narrows, causing discomfort. You'll find a range of medications available, such as NSAIDs, opioids, antidepressants, and others.
Still, experts don't entirely agree on their effectiveness in treating spinal stenosis pain. Before you decide to use any of these medications, discussing them with your doctor or pharmacist is essential to understand the best and safest approach.
Can painkillers make pain worse?
Opioids usually work well, but sometimes, they can actually make the pain worse. This unexpected response is known as opioid-induced hyperalgesia (OIH). If you think you may have OIH, speak to your doctor right away. It might help to take less of the medicine, stop taking it completely, try a different kind of opioid medicine, or use a different type of pain medicine that doesn't contain opioids.
Can I take painkillers if I have high blood pressure?
Painkillers such as NSAIDs, antidepressants, and steroids may raise blood pressure. You can still take pain relievers, but your doctor will need to select the medication and monitor you closely.
Are painkillers safe for the liver?
Most painkillers are removed from the body by the cleansing work of the liver. If your liver function is normal, FDA-approved doses of painkillers prescribed by your doctor should not cause problems. If you use painkillers, your doctor will monitor your liver function tests on a regular basis. Avoiding alcohol use with any painkiller, especially acetaminophen, will lower your risk of developing liver problems.
- The Journal of Pain. Non-surgical interventions for lumbar spinal stenosis leading to neurogenic claudication: a clinical practice guideline.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Spinal Stenosis.
- American Academy of Orthopedic Surgeons. Lumbar spinal stenosis.
- Food and Drug Administration. Understanding unapproved use of approved drugs "off label."
- Food and Drug Administration. Medication guide for non-steroidal anti-inflammatory drugs (NSAIDs).
Show all references
- Cochrane Library. Systemic corticosteroids for radicular and non‐radicular low back pain.
- Food and Drug Administration. Safe Use Initiative - epidural steroid injections.
- The British Medical Journal. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews.
- Food and Drug Administration. Medication guide for antidepressant medicines.
- Centers for Disease Control and Prevention. Opioids: patients’ frequently asked questions.