Optimizing Pain Control in a Patient with Lumbar Spinal Stenosis: A Report of Clinical Management

Raymond E. Kennedy, Christopher Hildebrand

DOI: https://doi.org/10.7175/cmi.v12i1.1336

Abstract

Lumbar spinal stenosis is a leading cause of low back pain and one of the most common causes of work absences. Treatment is initialized with narcotic and non-narcotic medications, which have been shown to work in the majority of patients. For those who do not find relief with medications and seek pain/symptom relief, invasive spinal surgery is the last resort.

This case describes the escalation and dose titration of narcotic and non-narcotic medications in a patient with worsening lumbar spinal stenosis that was unable to proceed with surgical intervention for the next several months and had failed his prior outpatient pain regimen. Proper titration of a basal narcotic dose in addition to optimizing non-narcotic medications, including muscle relaxants, proved to better control pain in the interim until surgical intervention. Our case shows how several different teams of physicians and non-physician providers collaborated to optimize pain control using several different treatment regimens with different doses and routes until a safe and effective plan was created for long-term use.

Keywords

Spinal Stenosis; Spinal Diseases; Analgesia; Pain Management

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References

  • Waddell G. The Back Pain Revolution. ed. 2. London: Churchill Livingstone, 2004
  • Parker SL, Godil SS, Mendenhall SK, et al. Two-Year Comprehensive Medical Management of Degenerative Lumbar Spine Disease (Lumbar Spondylolisthesis, Stenosis, or Disc Herniation): A Value Analysis of Cost, Pain, Disability, and Quality of Life: Clinical Article. J Neurosurg Spine 2014; 21: 143-9; https://doi.org/10.3171/2014.3.SPINE1320
  • Deyo RA. Treatment of Lumbar Spinal Stenosis: A Balancing Act. Spine J 2010; 10: 625-7; https://doi.org/10.1016/j.spinee.2010.05.006
  • Markman JD, Geandter JS, Frazer ME, et al. A Randomized, Double-Blind, Placebo-Controlled Crossover Trial of Oxymorphone Hydrochloride and Propoxyphene/Acetaminophen Combination for the Treatment of Neurogenic Claudication Associated With Lumbar Spinal Stenosis. Spine 2015; 40: 684-91; https://doi.org/10.1097/BRS.0000000000000837
  • Barlas S. U.S. and States Ramp Up Response to Opioid Crisis: Regulatory, Legislative, and Legal Tools Brought to Bear. P T 2017; 42: 569-92
  • Institute of Medicine. (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press, 2011

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