Spinal Stenosis: Causes, Symptoms and Treatment

Medicine Corner with Dr D 

Spinal Stenosis

Chronic back pain can be a result of spinal stenosis. Spinal stenosis is usually seen in individuals over the age of 50 who developed significant degenerative changes in their spine from wear and tear. The medical word for these degenerative changes is osteoarthritis. Spinal stenosis is a result of the narrowing of the spaces within the spine where the spinal nerve roots are located. When the spaces get too narrow, excessive pressure on the nerves in the area develops.

Back StrainSciaticaDisc HerniationFacet Joint Pain

Symptoms

People affected by spinal stenosis may experience a variety of symptoms. Some individuals may have no symptoms at all, especially in the initial stages, while others may experience significant amount of pain. It is not known why some people experience more or less pain. Spinal stenosis is a degenerative disease and therefore develops slowly over period of time with gradually worsening symptoms. Most individuals experience tingling and numbness in their buttocks, legs, and calves, especially after prolonged walking. Walking up the hill or up the stairs is particularly painful, but even walking down the stairs can lead to significant amount of pain. In more advanced cases, weakness of the legs, pain, and cramping in one or both legs and feet can present with prolonged standing or walking.  In severe cases, an individual may not be able to walk more than few blocks before severe pain develops.

Urination and bowel movement can also be occasionally affected as a result of the pressure on the spinal nerves that control these two essential physiologic functions, and the individual may develop urinary urgency and incontinence. In general, the back pain from spinal stenosis gets better with sitting down for a few minutes. Sitting flexes the spine and this relieves some of the pressure on the nerves. Many individuals with severe spinal stenosis, therefore, walk stoop forward and keeping their torso slightly flexed to lessen the pain while walking.

Causes

There are several reasons why spinal stenosis may develop. The most common causes include osteoarthritis and bone spurs. Osteoarthritis is one of the forms of arthritis. It is a result of wear and tear that affect the protective cartilage on the ends of the bones. When osteoarthritis is present in the spine, it can cause over time narrowing of the spinal canal, which eventually results in spinal stenosis. When bone spurs develop as a result of long term wear and tear, the spurs may grow inside of the spinal canal and cause pressure on the spinal nerves. Less frequent causes of spinal stenosis include a spinal tumor and a car accident. In both of these cases, there are usually several other prominent symptoms that point out to that diagnosis.

Treatment guidelines

In mild cases of spinal stenosis, a conservative treatment approach is recommended. This may consist of physical therapy and strength training, stretching, short term course of acupuncture, daily stretching, swimming, Tai Chi or Yoga exercises. The goal is to keep the back muscle flexible and relaxed as much as possible. Building core strength is also important to properly distribute the weight and decrease the load on the spine. Losing excessive weight is crucial for the successful management of back pain. Carrying less weight translates to less pressure on the lumbar area of the spine from the excessive forward pull of the abdomen.

 

In more severe cases when the benefits of conservative treatment have been maximized, but pain continues to significantly affect the quality of life, surgery may be necessary. This should be however the last resort since there are inherent risks to any surgical procedure. It has been recommended, that only when all other treatment options have been exhausted, and the individual’s quality of life as it is now is poor, surgery should be considered as a possibility to improve current quality of life.

 

For more information about spinal stenosis you can visit the Mayo Clinic Spinal Stenosis page

by Dr. Michal Domeny DNP, L.Ac, CD/N

Acute Pain Management: A Guide to Complementary Therapies

Complementary Medicine

Acute Pain Management: A Guide to Complementary Therapies

Increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of side effect.  There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world. It is also true that every medication carries a risk of side effects.

 

Complementary medicine such as acupuncture, massage, yoga and meditation has been used to ease the pain and treat acute and chronic injuries long before contemporary medicine became the standard of care. The question arises, should we shy away from conventional pain medication for controlling acute pain and focus primarily on complementary modalities, because they are generally safer and mostly free of side effects?

 

In this post I will try to present unbiased view of  both sides and attempt to come up with the answer that I have found in my practice most successful.

Conventional medicine and acute pain

Conventional pain medication maintains a bad rap in minds of many people. This is especially true for those who are more in tuned with their body and look for complementary medicine as the primary treatment option for their daily maladies.

 

While managing daily aches and pains with stretching, massage, yoga or acupuncture is definitely very reasonable and preferred option, situation slightly changes in case of intense acute pain.

 

It is important to understand that there is a role for pain medication when it comes to severe pain. Getting your pain under control as soon as possible will prevent altering the way your brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize your brain to pain and lower your pain threshold. This ultimately translates to experiencing pain from similar injury in the future at much lower level than before.

Complementary medicine and acute pain

Complementary medical modalities have been used successfully for management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their primary role is generally seen in management of chronic conditions. This is largely because their main mechanism of action, by which they help to promote recovery, is through stimulating body’s own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain. But that doesn’t mean these modalities cannot be used successfully even in cases of significantly severe pain.

 

There are many practitioners who are quite skillful and capable to accomplish “miraculous” results. This author has treated successfully many patients with significant amount of acute pain in his own private practice with acupuncture and herbal medicine.

 

The problem with using modalities such as acupuncture for treatment of severe acute pain, becomes with the access to these skillful practitioners and the associated cost. In case of acupuncture, it takes years of experience, and additional training in treatment of musculoskeletal injuries to treat patients with severe acute pain, to achieve reliable results.

 

When seeing an acupuncturist for treatment of chronic conditions, weekly sessions are generally sufficient to achieve great results. This is, however, not true in case of significant acute pain.

 

To successfully treat an acute pain, the practitioner will need to see the patient generally up to three times a week for the first two weeks and usually will also prescribe an herbal formula. At the average cost of $70 -$100 per office visit, this can easily add up to $300 - $400 a week x 2.

 

This also does not account for the travel time to and from the office and lost work. Compared to a small co-pay for an office visit with a primary care provider and pain medication if the patient has a medical insurance, this becomes a significant financial burden that majority of patients cannot afford. Just because it is possible, doesn’t therefore mean that it is always feasible and the right thing to do.

Conventional medicine and acute pain

Conventional pain medication works in completely different way. When taking pain medication, the goal is not to restore the body’s homeostasis, or to support the body in its own ability to take care of the pain. The pain medications are designed for one and only purpose. To suppress the pain as fast as possible and as much as possible.

 

There are many different classes of pain medication and they all work in slightly different way. Some of them can be purchased over the counter to suppress mild to moderate pain, but for the severe pain, it is usually necessary to see a medical provider who can write a prescription.

 

While opioid medications are the most powerful tools that we have in our pain arsenal, there are other options which are not classified as opioids, and which your provider can prescribe to control your acute pain.

 

It should be therefore clear, that prescribing pain medication for severe pain, does not necessarily equal prescription for opioids, if that is something that the patient does not feel comfortable with. It is however noteworthy, that taking seven to ten day course of opioid medication is usually sufficient to get even the most severe pain under better control. Different class of pain medication can be prescribed after the initial seven to ten day course of opioid medication, to provide sufficient pain relief.

 

This short course of opioid pain medication is rarely causing any more side effects then some drowsiness and sleepiness. Most individuals with acute severe pain prefer to take this medication only at night when pain becomes more intense, because all the daily distractions are taken away by the silent night.

 

Opioid pain medication is therefore particularly helpful to take before sleep to ease the severe pain and allow for better sleep. To keep the dose of the strong opioid medication as low as possible, the provider usually prescribes one or two other pain medication that work through different mechanism and add to the total pain relieving effect.

Eclectic Approach

An eclectic approach to pain management is in this author’s opinion the best. In the eclectic approach, the patient uses combination of several modalities which complement each other to achieve the best result.

 

Combining one or several complementary modalities such as acupuncture, acupressure, massage, yoga, breathing exercises and meditation along with pain medication, will have much greater effectiveness than using any of them as a standalone modality.

 

This combined approach takes the best from both worlds so to speak. The complementary medical modalities slowly work on helping the body recover faster, while pain medication helps to control the acute pain and allows the patient to focus on the recovery process.

 

Getting sufficient amount of sleep, staying physically active and following an anti-inflammatory diet will further maximize the healing. For more details on how to optimize your recovery process follow this link.

 

To learn more about complementary therapies, visit National Center for Complementary and Integrative Health

by Dr. Michal Domeny DNP, L.Ac, CD/N