Pain Management of Lumbar Stenosis

Lumbar spinal stenosis can cause persistent pain and discomfort, making daily activities challenging.

Effective pain management strategies can help improve mobility and enhance quality of life.

Here is a list of options to help you find effective pain relief for lumbar spinal stenosis.

Over-the-Counter Topical Pain Relievers

Topical treatments can provide targeted pain relief directly near the painful spinal segment(s) and tend to be fast-acting.

Common pain-relieving ointments for spinal stenosis include:

• Capsaicin Cream – Helps reduce pain by decreasing nerve sensitivity.
• Menthol-Based Gels (e.g., Biofreeze) – Provides a cooling sensation that can temporarily numb pain.
• Lidocaine Patches or Creams – Numbs localized areas of pain for temporary relief.
• NSAID Creams (e.g., Voltaren Gel) – Helps reduce inflammation in affected areas.

These creams and topical ointments are a preferred choice for many patients as they are applied to the local area and penetrate through the skin.

The topical agents do not have the same level of potential risks and adverse side effects of oral pain medications.

Use Heat and Ice Therapy

Both heat and ice therapy can be effective for managing lumbar spinal stenosis symptoms, but they serve different purposes:

Heat Therapy
Applying a heating pad or hot water bottle over tight muscles in the lower back provides a surprising level of pain relief:

• Relaxes overly tight muscles
• Helps prevent painful muscle spasm
• Stimulates blood flow to the injured area, which promotes and accelerates the healing process

Learn how to apply heat therapy

Cold Therapy
Icing the lower back after activity or exercise is an easy and effective way to reduce lumbar spinal stenosis pain at home.

The goal of ice therapy is to numb the affected area and achieve temporary pain relief.

If there is a lack of sensation in the lower back area, do not use ice or heat to avoid damaging the skin.

Learn how to apply cold therapy

Relieve Tightness through Myofascial Release

This hands-on therapy focuses on relieving tension in the fascia, the connective tissue throughout your body that surrounds muscles.

Myofascial release therapy helps reduce pain by loosening tight areas that may contribute to discomfort.

This type of therapy is performed by a physical therapist, massage therapist, or other health professional trained in myofascial techniques.

Therapeutic Massage

Massage therapy provides multiple benefits, including relieving muscle tension, increasing circulation which in turn brings healing nutrients to the damaged area.

Types of massage therapy that are commonly used are:

• Deep Tissue Massage – Targets deeper layers of muscle to relieve chronic pain and stiffness.
• Swedish Massage – Uses lighter pressure to promote relaxation and reduce mild discomfort.
• Trigger Point Therapy – Focuses on specific areas of muscle tightness that may be causing pain.

Water Therapy in a Warm Pool

Exercising in warm water is an effective, low-impact way to relieve pain and improve mobility:

• Buoyancy provided by the water minimizes stress on your joints – the water supports the body, reducing strain on the lower back.
• Warmth Relaxes Muscles – the pool is heated to a comfortably warm temperature, helping ease muscle tightness, reduce muscle spasm, and improve circulation.
• Low-Impact Exercise – participating in a water therapy exercise class allows for movement without excessive pressure on the spine.

For some people, movement and exercise in a warm pool has the effect of a strong pain reliever, combined with the benefit of building muscle strength and flexibility.

Many people with spinal stenosis also have some degree of spinal osteoarthritis, and water therapy is an effective treatment for both conditions.

Pain Medications

The best painkiller for lumbar spinal stenosis is driven by several factors, such as how you react to various medications, the degree of nerve involvement and claudication, and/or if you have additional conditions such as spondylolisthesis or spinal osteoarthritis.

Here are the most common pain medications used:

• Ibuprofen (e.g. Advil, Motrin) – A nonsteroidal anti-inflammatory drug (NSAID) that reduces pain and swelling.
• Diclofenic - A strong nonsteroidal anti-inflammatory drug (NSAID) that reduces pain caused by inflammation.
• Acetaminophen (e.g. Tylenol) – Helps alleviate mild to moderate pain but does not reduce inflammation.
• Oral steroids - In more severe cases, an oral steroid may be prescribed for severe, acute pain.
• Muscle relaxants – Spinal stenosis can cause muscle spasms, which can be quite painful, and if this is the case a short course of muscle relaxants may provide relief.
• Nerve pain medications - For severe nerve pain, such as sciatica pain that runs down the leg, a nerve pain medication (such as gabapentin or pregabalin) may be helpful.
• Arnica – A natural remedy that may help reduce inflammation and muscle soreness. This may be a preferred option for people who want to avoid the risks and side effects of ibuprofen.

All medications, including non-prescription medications, have potential risks and adverse side effects and need to be taken under the guidance of your treating physician.

Chiropractic Care

Chiropractic adjustments may help relieve pressure on the spine and improve mobility:

• Spinal Manipulation – Adjustments performed by a chiropractor that seek to realign the spine and reduce nerve irritation.
• Mobilization Techniques – Gentle movements to improve joint function and flexibility.
• Complementary Exercises – Most chiropractors incorporate stretching and strengthening exercises to support spinal health.

Spinal Injections

For individuals with significant pain that does not respond to oral medications, spinal injections may be an option:

• Epidural Steroid Injections (ESIs) – this injection places strong anti-inflammatory corticosteroids directly into the affected spinal area with the goal of reducing inflammation and pain.  The effects are temporary and differ from individual to individual.
• Facet Joint Injections – this type of injection places an anesthetic and/or steroid directly into the facet joint in the stenotic spinal motion segment with the goal of reducing localized inflammation and pain.
• Nerve Blocks – a nerve block, usually a selective nerve root block, puts an anesthetic and/or steroid directly near the nerve root as it exits spinal motion segment affected by spinal stenosis.  This temporarily numbs the specific nerve(s) to block pain signals from reaching the brain.

Final Thoughts

Managing lumbar spinal stenosis pain requires a combination of strategies tailored to individual needs.

For most people, it is best to use a trial-and-error approach to see what works best for you.

These pain management approaches, combined with spinal stenosis exercise and lifestyle modifications, can go a long way to helping keep pain to a tolerable level and helping you stay active and mobile.

If you have made a concerted effort at managing pain through nonsurgical treatments without effective pain relief, it may be time to consider surgery.  The most common types of surgery for lumbar spinal stenosis are:

• Lumbar laminectomy or a laminotomy (which is a partial laminectomy)
• Lumbar foraminotomy
• Interspinous process spacer

If there is instability (such as spondylolisthesis) in addition to the stenosis, a lumbar fusion or TOPS system may be considered.