Opioids for spinal stenosis

Examples

Generic Name	Brand Name
morphine	Astramorph, Roxanol
oxycodone	OxyContin, Roxicodone
tramadol hydrochloride	Ultracet, Ultram

Opioids in combination with other analgesics:

Generic Name	Brand Name
hydrocodone bitartrate and acetaminophen	Lortab, Vicodin
oxycodone and aspirin	Percodan

How It Works

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

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

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

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

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.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: February 21, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics
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