Opioids for spinal stenosis

Examples

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Brand Name	Generic Name
Roxanol	morphine

Brand Name	Generic Name
Roxicodone	oxycodone

Brand Name	Generic Name
Ultram	tramadol hydrochloride

Opioids in combination with other analgesics:

Brand Name	Generic Name
Vicodin	hydrocodone bitartrate and acetaminophen

Brand Name	Generic Name
Percodan	oxycodone and aspirin

How It Works

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Opioids are prescription narcotic medicines that are similar to pain-relieving substances naturally produced by the body (endorphins). Opioids suppress your perception of pain by reducing the number of pain signals sent by the nervous system and calm your emotional response to pain by reducing the brain's reaction to pain signals.

Why It Is Used

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Opioids are sometimes used to relieve flare-ups of low back pain caused by pressure on the spinal cord due to lumbar spinal stenosis. Stenosis can squeeze and irritate the nerve roots, causing moderate to severe pain. Health professionals who specialize in treating pain in adults with degenerative conditions such as spinal osteoarthritis believe that opioids can be a responsible choice for treatment if pain is not relieved by other forms of treatment and if you are unable to engage in daily activities.¹ Opioids are usually used only for short periods of time, which helps you avoid side effects.

How Well It Works

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Oxycodone, in both immediate-release and controlled-release doses, has proved to be effective in relieving moderate to severe pain symptoms of osteoarthritis, which is a common cause of spinal stenosis. Tramadol, when used alone or in combination with a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen, is also effective in relieving pain caused by osteoarthritis.¹ Opioids do not relieve inflammation, so they are often combined with an anti-inflammatory medicine.

Side Effects

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Older people in particular may experience side effects from opioids. Side effects can include:

• Constipation.
• Urinary retention.
• Mental confusion.
• Drowsiness.
• Nausea and vomiting.

Side effects of tramadol include nausea, vomiting, and nervousness. Tramadol may increase your risk of having a seizure.

Taking opioids can make you unsteady on your feet. This could make you more likely to fall and hurt yourself when you try to do your normal daily routine.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Lumbar spinal stenosis often develops in older people who may find that the side effects from opioids are worse than their back and leg symptoms. For this reason, opioids are not often used as treatment for lumbar spinal stenosis.

You may become physically dependent on opioids if you take them regularly. Physical dependence is not addiction, but rather a gradual change in your body in response to the opioids. If you stop taking opioids abruptly, you may develop nausea, sweating, chills, diarrhea, and shaking. These are symptoms of withdrawal from the opioid. This physical dependence is not life-threatening and can be avoided if the opioids are tapered off over a set period of time, as prescribed by your health professional.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Simon L, et al. (2002). Opioids. In Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2nd ed., chap. 4, pp. 81–90. Glenview, IL: American Pain Society.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	February 21, 2008