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


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.


Spinal Stenosis; Spinal Diseases; Analgesia; Pain Management

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