Spinal Stenosis-A Personal Chronicle-Part I of a II Part Article on Stenosis

Please also see: Tips on How to Keep Your Back Healthy and also Low Back Pain- Does Treatment Help?

(2/28//08)- To operate or not to operate; to get a steroidal cortisone shot or not to get a shot; to try and deal with the problem of spinal stenosis with physical therapy or some other possibility are all potential methods of treatment questions faced by all of us who have the disease. In my own particular case I have written about how I have dealt with the problem through the "spinal steroidal cortisone shot" methodology. The purpose of my article is not to make the selection for any of the viewers herein, but to hopefully keep you updated on what modern science has available to treat the problem.

Last April, the results from the Spine Patient Outcomes Research, or Sport that degenerative spondylolisthesis,another common spinal problem and herniated discs had no better outcomes when treated with spinal surgery than if treated by physical therapy. This study was started in 2000, and was paid for by the National Institutes of Health.

The trial involved about 2,500 patients at 13 treatment centers around the country. Patients were initially divided into surgery and non-surgery groups, but during the various related studies many people randomly changed their minds and opted for the other type of treatment. The study was headed by James N. Weinsteing, surgeon and chairman of orthopedics at the Dartmouth Medical School in Hanover, N.H.

The results of the study in relation to spinal stenosis were published in a recent edition of the New England Journal of Medicine. The results showed that spinal surgery was the most effective way to deal with spinal stenosis. Dr. Weinstein stated: "I still believe we have too much spine surgery overall, but this study shows that where there is a "specific diagnosis of stenosis, spine surgery will bring a benefit."

The study followed 803 patients, of whom 398 ended up getting surgery. After two years, of those who had surgery, 63% said they had a major improvement in their condition, compared with 29% among those who got non-surgical treatment.

In terms of self-reported pain and physical function both groups improved over the two-year period, thought the final scores for patients who had surgery were in the 60% range, while scores for those who stuck with non-surgical treatment were in the 40 range.

In regards to my own experience in connection with my bout with spinal stenosis, it is now about 7 months since my last spinal steroidal cortisone shot, but this time unlike my comments from 12/2/07 "trouble had been brewing". I will update you on what has been happening to me, and I would appreciate any feedback that any of you may have as to whether or not you have had a similar experience. I would also appreciate hearing from those of you who went the route of having the operation, and your ensuing comments about that procedure.

About 4 weeks ago my pain level moved up into the 3-4 area over a period of time. I began to feel a "tightening" pain in the right calf muscle. It was not a bad pain level but it was increasing slowly but surely. At the same time I began to experience soreness for the first time in my right side above my hip-bone, and in the right buttock area. I could continue to walk so I carried on with only a 3-4 level of pain while doing so. This time, unlike my previous experiences with the problem in 2002 and 2004, I did not have any pain in the groin area.

It was about 30 days ago that the "tightening" in the right calf muscle became more and more of a problem. The pain on my right side also increased, but now my walking pain reached the 4-5 level. As anyone who has had stenosis can tell you, as time passes you never forget how bad the 10 level pain is, so lesser degrees of it are much more bearable.

About 25 days ago was when I knew that the problem was surely not getting better, and not going away. Even though my first and second shot experiences, as I described below, had lasted for a 2 year and 3 year period of time I did not think I could go on much longer before calling my pain management doctor to arrange another shot.

The pain management doctor had told me, that since the shot had worked before, the likelihood was that it would work again, I am not anxious to have it done, because I am aware of the fact that it is not good for the rest of my body.

Believe it or not, what caused me to put off the call off was my recollection of the fact that I previously improved spontaneously after holding out for a few more days. Obviously the pain level had remained relatively low, by which I mean it never got above the 6 level.

When I woke up on the morning of February 11^th I immediately sensed that my pain level had gone down perceptibly. I am writing this add-on item to this article the night of the 11^th, and my pain level is back down to the 1 to 3 level, and yes, it may be my imagination, but I think the episode is behind me for now. I did not post this item until this date because I wanted to make sure that this episode was truly and thankfully behind me.

(12/2/07)- It is now about 5 months since my last spinal steroidal cortisone show and all is well with myself. My pain level is still at the 1-2 mark and I am able to do an unlimited amount of walking with no problem. I have no idea how long it will last but I am just thankful that it is no problem for me at all.

The following sites were listed in a recent article, dated November 20, 2007 by Jane E. Brody in the N.Y. Times, entitled: "Many Treatments Can Ease Chronic Pain":

American Chronic Pain Association: e-mail- ACPA@pacbell.net Web site- www.theacpa.org Address- P.O. Box 850, Rocklin, CA. 95677-0850; (916) 632-0922 or (800) 533 3231.
American Pain Foundation: e-mail- info@painfoundation.org Web site- www.painfoundation.org Address- 201 North Charles St., Suite 710, Baltimore, Md., 21201-4111; (888) 615 7246
National Foundation for the Treatment of Pain: e-mail- Pain@cwo.com Web site- www.paincare.org Address-P.O.Box 70045, Houston, Tex., 77270; (713) 862 9332.

(8/17/07)- It is now slightly over one month since I got my last steroidal cortisone shot, and so far so good. I would say that my pain level is in the 1-2 area and not creating any problems for me at all. I have resumed playing tennis and walking back and forth from work every weekday without having the pain interfere with the activity.

Of course every morning when I get up I cautiously put my feet onto the floor wondering if my legs will be okay. That feeling will never go away, but so far it is no problem at all.

The first time I got the shot it lasted 2 years and the second time I got the shot it lasted 3 years. Will this shot last for years or will the pain resume today? That question will always be with me, but it is in the back of my mind, and does not impede me in any way from doing whatever physical activity I choose to do on a particular day.

Unfortunately I have heard of a case in the last week where the steroidal shot did not work As far as I know there is no way to predict if the shot will work or not.

(7/14/07)- It is time for me to update you as to what has happened to me since I wrote the last item about my stenosis problem on May 27^th below.

Throughout the end of May and early June the pain in my leg continued to elevate so that by June 2 I knew that I could not wait until July 3 to get a shot. I called my pain management doctor's office to see if I could get the date for the shot moved up but the doctor did not return my call. If you go to the earlier items that I have written about my "stenosis saga" you will see that this was not an unusual occurrence.

Finally I got in touch with my personal physician and had him call the office of the pain management doctor. Although my pain management doctor was not available for an appointment earlier than the July 3 date, his associate was available for a June 11 date so I readily accepted that day to get the epidural.

By June 11 my pain level was up to number 10. Please keep in mind that 1 is the lowest level of pain and 10 is the highest.

I arrived at the doctor's office on June 11^th and after a short wait I was taken in to see the physician's assistant for an interview as to my problem. She had all my prior records available in connection with my visits to this office in July 2002 and July 2004. After this interview the doctor came in and he also asked me about my problem.

He told me that the procedure has changed since I received my last shots in July 2004. He explained the new procedure to myself and I agreed to take the shots. I use the word shots because it entailed receiving more than one steroidal cortisone shot. The shots are not injected directly to the spine as they were done before.

I was told, as I was on the prior occasions that I was given the shots, that it would take between 3-5 days for me to start to feel some positive effects from it. My pain level did go down in the following weeks but not to the point where I had hoped it could get. I knew that I was not home free so I tried calling my regular pain doctor again, but this time I was able to get in touch with him.

His office told me that the July 3^rd date was still available so I gladly accepted that day. He told me however to go have some a new MRIs taken since the last one that they had was the one I took in 2004. His office faxed the prescription to me and I in turn called the imaging office to schedule an appointment.

The imaging organization did MRIs on Saturday, so I was able to get an appointment for the earliest time on Saturday. As an aside, it was great to go to the imaging organization on a Saturday morning and find it empty except for myself. In all my prior MRI sessions in the prior years that I took it the office was mobbed.

My pain management doctor had me take the MRI in the same office as my prior one in 2004, since he felt that they were therefore best informed when it came to comparing the present MRI with the past MRI. I got to the pain management doctor's office in time for my appointment, and once again his physician's assistant interviewed me.

She spent about 10 minutes interviewing me and taking notes. I indicated to her that I was not sure if I should get the shots since my pain level was in the 4-5 range, which was better than the 10 level when I got the shot.

My doctor appeared in the examining room shortly thereafter and he showed me the results of my MRI. He indicated to me that there were two main areas of concern that showed up in the MRI. The main problem he felt that was causing my pain was an inflamed disc between L5 and S1 that my right leg nerve was rubbing against. The other main problem area was the stenosis or arthritis between L5 and L 4.

We then went on to discuss the options available to me in connection with treating what he felt was the main cause of my problem-the disc inflammation between L5 and S1. We could do nothing and see if there was any continuing slow improvement without any treatment, or take a more aggressive approach and take the shots.

He explained to me what I already knew. If you left it alone to improve by itself this could easily fail. If you took the shots there was no assurance that the shots would work. He was very fair and impartial in allowing me to arrive at my own decision in the matter. I opted to take the shots.

I then was taken into the room where the procedure was performed. In addition to the technician who operated the fluoroscope machine and my pain management doctor, there was a second doctor in the room. It turned out that this doctor was an associate of my doctor who was new to the office. He asked my permission to allow this doctor to be present because he wanted to show him how he did the procedure.

The entire procedure took about 15 minutes. It was not painful, but I sure wouldn't call it a carefree session either. I felt no ill effects from the procedure, and was able to dress and go home right after it ended.

For the first few days after July 3^rd there was no improvement, but in the ensuing days the pain in my right leg slowly but surely began to subside. It came down to a 3 level and I was able to resume walking to and from work, which incidentally is about a 40 block walk each way.

As of this writing my pain level is in the 2-3 area which is easily manageable. I can walk wherever I want to go and it is not a problem. I have no idea how long it will last, and I take each day as it comes. Will it last 3 years as the last shots lasted or will my relief end tomorrow? I don't know. All I do know is that I am walking with a very low pain level and it surely is very manageable.

I know that our item dated 5/28/07 below, which deals with lumbosacral pain is not an encouraging one for this condition. Be that as it may, all I do know now is that I am quite content to be able to do what I am physically doing now.

(5/28/07)-Based on a literature review, the American Academy of Neurology Therapeutics And Technology Assessment Subcommittee has drafted new guidelines on the role of steroid shots for lumbosacral pain. The lead author of the study was Dr. Carmel Armon, chief of neurology at Baystate Medical Center in Springfield, Mass, and professor of neurology at Tufts University in Boston. His search of the literature yielded 37 studies, but only 4 met the committees predetermined standards. All 4 of these studies concluded that the injections proved "no efficacy at 24 hours, some efficacy at 2-6 weeks, no difference or rebound worsening at 3 months and 6 months, and no difference at 1 year."

Dr Armon is quotes as saying: "While some pain relief is a positive result in of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful."

Complications of epidural steroid injections are usually minor and transient. The most frequently reported symptom is a headache. Rare major complications include aseptic meningitis, epidural abscess, arachnoiditis, bacterial meningitis, and conusmedullaris syndrome.

According to Dr. J.D. Bartleson, a neurologist at the spine center of Mayo clinic in Rochester, Minn, "Epiduaral steroid injections are likely overused. There is a bias that they are extremely helpful, which is not bourne out by the data."

(5/27/07)- I am now approaching the 35^th month since my last spinal cord streoidal shot, and I am beginning to feel the pain from the stenosis returning in my right leg. I am fortunate that it has taken this long before returning, because in most cases, the relief from the shot lasts only up to 24 months, if it even works at all.

Fortunately and strangely enough this time the pain is not that great when I walk so as to prevent me from walking. The pain is at its highest level when I sit (at the 5-6 level). I remember the doctor told me that sitting causes the most pressure on the spine.

The pain is in my thigh and calf muscle, but I am not experiencing the pain that I had the last time in my hip area. I called my pain management doctor's office on May 25^th, and I was told that the earliest date that I could get for an appointment for the shot was July 3. That sure is a long way away from May 25^th, but I will just have to manage until then. Since I can walk relatively pain free I hope to be able to make it, and continue to be able to go to work.

At first I stopped doing my leg exercises for 5 days, since I could feel the pain coming on and thought that might help, but I shall resume doing them, and see if that helps any.

A new program sponsored by the National Committee for Quality Assurance (NCQA), an organization that monitors health-care quality and accredits health plans has determined that there has been overusage of steroid injections in connection with back pain.

The NCQA will rate doctors on whether they advised patients to maintain normal activities and avoid more than four days of bed rest. The organization will measure the percentage of patients with back pain who received an epidural steroid injection without radiating pain. These injections are most effective for the treatment of pain that radiates along nerves caused by more serious conditions such as a herniated disk.

(10/20/06)- We at therubins received the following email from one of our viewers:

"how come on the articles with regard to spinal stenosis not a word mentioned about healthy eating, supplements, minerals etc. t.s."

Stenosis is a horrible disease that alters the afflicted individual's quality of life. You will try anything to alleviate the pain. As the article pointed out, I tried everything from acupuncture to painkillers, etc, In my case the spinal steroidal injection has alleviated the bulk of my pain. I do my stretching exercises, and so far it is under control.

In the email cited above, the viewer asks about eating right, dietary supplements, minerals, etc. We would appreciate anyone who has had experience with any of these items to email and tell us about your experience with it. We will withhold naming you, or even putting in your initials if so requested.

If you have any other possible suggestions as to a treatment that either helped or didn't help please let us know about it. The items from our viewers will be posted in a separate article from this one located at Spinal Stenosis- What Has Worked or not Worked for Me - Part III of a III Part Article on Stensosis.

(10/18/06)- I am very happy to report that my spinal stenosis pain level has stayed at just about the same very manageable level that it was at when I last wrote about it on 7/19/06. I have not taken any gabapentin, or neurontin for many months now and I do think that the drug is just a mental crutch, and does not really help the condition.

The answer as to why my condition has stayed at a very manageable level has to be related to the stretching exercises that I have been doing. Please keep in mind that my pain management doctor estimated that the spinal steroidal cortisone shot would be good for about 24 months at maximum. It is now over 27 months since I got my last shot.

I do my stretching exercises very late at night, because I have found that is the time when I am most relaxed in doing them. In my case I do not have any background music, or anything else that I listen to because I feel it only distracts my attention when doing the exercises. I do not do all of my exercises every night, because quite frankly there are days in which I just plain don't feel like doing them.

On those days that I do not feel like doing them, or doing less of them then I should be doing, I listen to my "bad conscience" and just don’t do them. To do them properly it takes about 1 hour and 15 minutes each night. I do have a good deal of physical pain when I do them, and it is not any easier to do even if I have done them fully for say a week at a time.

For whatever reason that I do not understand, I curse a lot when I do them, and that is indeed very strange for me, since I do not normally curse. Once you have endured the pain of spinal stenosis, and seen how negatively it impacts your quality of life, you will try anything to keep it from coming back.

(7/19/06)- Spinal stenosis is a strange illness. When I last wrote about what was happening to me, I related how the pain had abated so that I was able to cancel the appointment for the spinal cortisone shot on April 7. My pain level stayed at a manageable 2-3 level for a few weeks thereafter, but then the pain started to return up to the 3-4 level.

By the middle of June my pain level had risen to the 4-5 level, and I started to take my 300-mg gabapentin pills twice a day. My pain level increased to the 5-6 level, and when it stayed there for a few days I called my pain management doctor's office to schedule a shot. The earliest date that I could get it would be July 28.

I wanted to get the shot sooner, but that was the earliest date available so I would have to live with it. I knew I was in trouble, because I was scheduled for the week of July 8 to do some volunteer work out of town that involved physical labor. I figured that I would have to cancel the volunteer work and stay home, and that was a big letdown to me.

By late June I cut down my intake of the gabapentin to one pill, once a day because I did not feel it was helping me. Shortly thereafter my pain level went back down to the 4-5 level and I cut out the gabapentin altogether. Slowly but surely my pain level continued to decrease. I had continued to do my stretching exercises throughout this whole period of time.

By the first week in July my pain level was back down to the 2-3 level and I was elated for two reasons. The first reason was because once you have had a pain level of 8 or above your quality of life become severely restricted. The second reason was that I knew I would be okay to do the volunteer work, and I had really wanted to do it.

As I write this item my pain level is in the 1-2 range. I will gladly settle for that for the rest of my life. Was it the gabapentin that did it? Was it my continuing to do my stretching exercises? Was it my strong desire to do the week's volunteer work? I have no idea as to what caused the improvement.

I am now into the 25^th month since my last shot. I have no idea when the pain level will become unmanageable again, but I am thankful for this added time that I have had, relatively pain free.

As they say: "Stay tuned". 

(4/4/06)- When I got my last spinal cortisone shot in July 2004 I was reminded of the fact by my doctor that it usually is good for about 2 years when, as and if it works. My first experience with the shot was in July of 2002, when I also was advised that it probably would be good for about two years, if it worked.

I was therefore a bit disappointed when the stenosis began to act up on me last week. This time however it was different than what had occurred the first two times that I had had the attacks.

The first time that I had the problem was in 2002 when the pain in my left leg was so severe that I could not walk for more than 10 feet without having to stop and rest. I could however lie down, and the pain would abate.

In the second episode in 2004, the pain took place in my right leg and once again I had a great deal of pain when I walked, but I could lie down, and the pain would abate.

In this most recent episode, I had minimal pain when I walked but I could not lie down without a severe pain ensuing. In the two prior episodes, the pain came upon me more or less gradually over a several weeks period of time, whereas in this third episode the pain came about very swiftly. One day I was feeling well, with a minimum of pain, while the next day I could not go to sleep because of how severe the pain was when I was lying down.

When I called my pain management doctor's office last Monday, they told me that April 17^th would be the earliest that my doctor could schedule me for the injection. The pain continued to worsen whenever I lay down, so after another call to his office they were able to move the date up to April 7.

I did continue to do the exercises, since I could walk and get around with a minimal amount of pain. On Tuesday, I read Jane Brody's column in the New York Times, wherein she wrote about how gabapentin (the generic version of Neurontin) had helped her with her menopausal symptoms. Please see our article "Herbal Usage for Hormone Replacement Therapy- Part IX."

Since I still had some gabapentin left over from when I first had used them in connection with my first episode with the stenosis I decided to experiment and see if they might help me now with my present pain. I have found that, for whatever reason, the pain is abating and not a problem now especially when I lie down.

I called my doctor's office to cancel the appointment for the spinal cortisone shot. Obviously I am monitoring the situation and will write again in this article to update how I am doing. I am presently taking the 300-mg dosage of gabapentin twice a day.

(11/1/05)- In discussing the stretching exercises that I do on a daily basis, I forgot to include a few pertinent details of my program. One of the most important items is the fact that I find it is best for me to do them very late in the day because I am much more relaxed at that time then I would be if I did them earlier in the day.

You have to be as relaxed as you possibly can be to do the exercises properly. When I am on the floor doing them my mind often wonders off, but in doing them late at night I stay much more relaxed then if I were doing them earlier in the day. Obviously each individual may vary in their thinking on this matter, so follow your own timing schedule in doing them.

There are days in which I do not want to do them. I can not understand why these days happen…maybe it is my own stubbornness, but they do happen. Every once in a while I will pass up doing them, but most of the time I will at least do the majority of them completely. Some of the time I may do as few as 50% of them but then I think about the level of pain that occurred when I had the full blown effect of the disease, and that usually makes me do a few more of them.

Probably the most unusual thing that I do when I am doing the stretching is that I curse a lot to myself as I do them. I normally do not curse at all during the day. The exercises do not hurt that much, and they certainly are not hard physically to do, but for some reason or other, it makes me feel better to curse as I do them, so what the heck, I lie there, do them to the best of my ability and silently curse away to myself.

When I do the exercises in their entirety, and do them properly, it takes about 1 hour of my time to get them done.

(10/26/05)- In her Personal Health column of October 4, 2005, Jane Brody wrote and excellent article entitled "What You Can Do About That Aching Back". Although the article is entitled to the aching back ailment, it dealt mainly with spinal stenosis. In my own particular case it was not the back that caused me the excruciating pain, but rather the pain in my left leg that was incapacitating me.

I would like to quote from her article because of all the interesting items that she pointed out in the article:

"Arthritis-the wear-and-tear kind- is by far the most common cause of a potentially debilitating disorder called spinal stenosis, a narrowing of the passageways for spinal nerves. The problem is most common in people over 50, though the young are sometimes affected through injury of a birth defect.

Not everyone with spinal stenosis has symptoms, but 250,000 to 500,000 American do, and with age as the leading risk factor, the number afflicted is expected to grow significantly as the population ages….

The spine houses all the nerves that enable the brain to tell the rest of the body what to do. The spine is a column of 26 bones, 24 of them vertebrae-7 in the neck (cervival), 12 in the upper back (thoracic0 and 5 in the lower back (lumbar). The other two are fused vertebrae that form the sacrum in the hip region and the coccyx at the base of the spine.

Vertebrae are linked by facet joints that stabilize the spine and, at the same time, allow it to bend. Ligaments keep the vertebrae in place during movements, and fibrous disks with jellylike centers provide cushioning between them.

Now for the crux of the problem: The spinal cord, a long bundle of nerves from the base of the brain to the second lumbar vertebra, passes through a bony channe called the spinal canal.

On its way, two spinal nerves-one to the left side of the body and the other to the right- emerge between the vetebrae, and another bundle of nerves, the cauda equina, extends from the end of the spinal cord.

If the channel for the spinal cord and its many extensions becomes narrowed, pressure on the nerves can cause pain, cramping, tingling or numbness in the area served by the nerve….

Arthritis is also associated with deterioration of the spinal disks, which flatten, become brittle and may develop tiny rips that allow the jellylike substance to leak and press on the nerves. The ligaments too, degenerate with age, becoming stiff and thick, shortening the spine,narrowing the canal and sometimes compressing nerves.

Other causes of spinal stenosis are tumors, trauma, Paget's disease of the bone, and a genetic disorder called achondroplasia….

Various diagnostic tests are sued to check for spinal stenosis or other problems that cause similar symptoms. Among then are spinal X-rays, CT scans, a CT myellogram, a bone scan and best of all, an M.R.I….

Drug remedies include over-the-counter or prescription painkillers like acetaminophen (Tylenol and the like) and nonsteroidal antiinflammaroty drugs (Nsaaids) like aspirin, ibuprofen, Celebrex or Mobic.

In conclusion I would like to reiterate my personal opinion that the most important therapy available to sufferers from spinal stenosis is the stretching exercises, that are painful to do, but I believe are worth all the pain and suffering that they cause. At the same time I have to admit that there are days that I pass up doing them because of how tough mentally as well as physically they are to do on a daily basis.

(9/14/05)- I think I have been able to dodge the bullet again for the time being in connection with my battle with my stenosis. I know that eventually it will catch up to me, but every day that I put it off is a plus.

About 3 weeks ago the pain level in my left leg went from 1-2, up to 2-3 and then up to 3-4. With a pain level of 4 I was able to continue to walk as much as I wanted to walk, but I was very tired at the end of the day. Because I was tired I decided to forego my stretching exercises and see what would happen. You really have to be ready psychologically to do the stretching, and I was not ready to do it. I let 4 days pass without doing any stretching at all, even though I continued to walk to and from work.

I took one ibuprofen tablet a day, but that was the only medication that I took. Finally on the 5^th day I gradually began to resume my stretching exercises. I felt very guilty that I was not doing them, and finally my conscience won out and I began doing them again. Gradually the pain level began to decline again so that I am now back at the 1-2 level, which is no problem at all.

I did not bother to call the pain management doctor, because I figured I would wait till it got up to 6-7 before giving him a buzz. I know that there is nothing that the doctor can say other than schedule me for another shot, but I am not anxious to take one of them unless it is absolutely necessary. I had two of them in July of 2002 and one in July of 2004, and even though it is not painful to get them, I realize that the shot is not good for the rest of the body.

(5/24/05)- One of the very nice things about living in a city like New York is that you will meet a lot of your friends out on the street when you least expect it. Sunday afternoon I ran into a woman who I have known for many years. She is a woman who I would estimate is about 65 years of age. Lo and behold she started to tell me about her battle with spinal stenosis.

Her story was very similar to mine. She had never heard of spinal stenosis till she was diagnosed with it herself, and then much to her amazement she found out how common the disease is among older people. It was her neurologist who diagnosed her condition, and he told her to try exercising, stretching and in doing these things she could hopefully avoid surgery.

Originally she was not getting any better, so she went to a second neurologist who recommended surgery for her. She did not want to undergo surgery so she went to a third neurologist who recommended physical therapy for her. At this point her pain was excruciating and she could not walk more than 10 feet without having to rest. The same certainly could be said for me, when I was at the height of my battle with the disease.

This woman did not have any spinal steroidal cortisone shots whatsoever. She attributes her improved condition to the ability to work her way through the pain as she was doing her physical and stretching exercises. She goes for her therapy three days a week, and does her stretching exercises in the morning. I on the other hand prefer to do my stretching exercises late at night. We both agreed that many days we have to force ourselves to do it, but yes it must be done.

At one point do your throw up your hands and say the therapy and exercise program that you are on is not working? No one can answer that question for you, but yes I do know there may come a point where you just have to give up the therapy and exercise program and try something else, so that you may restore some quality to your life.

At first the stretching and the treadmill did not help her, but she stayed with it. Slowly, ever so slowly, the therapy began to work. In her case it took over several months of hard, painful work and therapy before it all came to fruition. She still does have some pain, but nothing compared to what it was when the disease incapacitated her.

In my case I do my stretching exercises every evening, except when I get ornery and rambunctious and just do a few of them. It is painful, but nowhere near the pain that the stenosis was at its height. Five days a week I walk to and from work, meaning about a total of 4 1/2 miles a day.

Both of us agreed, that every morning when we take that first step out of bed, we dos so with a great deal of trepidation. Will the excruciating stenosis pain return? So far, so good, but we sure have learned to appreciate a simple thing like being able to walk.

(4/29/05)- Although I have not had to use any heat pads or spinal electrical stimulation in connection with my spinal stenosis it may be helpful to some of you to be aware as to some devices now available to consumers to help you with pain management. Researchers feel that heat affects certain nerve endings, which send signals to help block the sensation of pain. Heat also relaxes muscles and increases blood flow.

Modern science has come up with several devices to improve on delivering heat to the body by methods better than the old heat pad that confined your mobility. One of the latest heat wrap pads contain gel or beads that are heated in the microwave and can stay warm for between 30 to 60 minutes. It is a moist heat, which some doctors believe is more effective as a pain reliever than other types of heat. Many of these same gel products can be frozen and used to reduce swelling after an acute injury such as a sprained ankle.

Proctor & Gamble has a disposable eight-hour wrap product called ThermaCare that contains iron, which produces continuous, low-level heat when exposed to air. The price for these disposable products is about $3.50 apiece. Heat should not be used if there is bruising or swelling.

Medtronic Inc. has received FDA approval for an implantable rechargeable spine stimulator that can last up to nine years. Advanced Neuromodulation Systems Inc. has also received FDA approval for its implantable rechargeable spine stimulator called Eon Neurostimulation System, and Boston Scientific's product in this medical equipment area is called Precision.

(4/13/05)- As I had suspected the Neurontin, and/or gabapentin, the generic version, thereof were really not helping me in my battle against spinal stenosis. It has now been 4 weeks since I have taken even one of the gabapentin and my pain level did not worsen. I would like to recap that situation for you in regards to the Neurontin.

After I had been treated for my spinal stenosis with injections of cortisone into my spine in July 2002, I also began to take Neuronitn (300mgs), the epilepsy drug three times a day. It was an off-label usage, but the doctor felt it might be helpful in alleviating the pain in my foot. I was able to decrease my intake of the drug to one time a day, but as hard as I would try, I could not completely eliminate taking the drug. My problem in eliminating the drug entirely revolved mainly around my fear of the pain level increasing back to the 6-7 level from the 2-3 level that I was at. A lot of that is due to the psychological fear that I had, but once you have experienced the pain of spinal stenosis, the fear does not go away.

I tried to eliminate the drug several times before this last time, but each time before this last time, I would give in once my pain level got back to 4-5 for fear that it would worsen. I finally was able to stick to the elimination of the drug entirely on this last attempt.

In my opinion the thing that has helped me the most in the battle with stenosis has been the physical stretching and walking exercises that I have tried to do on a daily basis. There are three different stretching exercises that I do repetitively three times each day. If you have stenosis I am sure your physician or medical professional has given you physical exercises to perform to help your condition. I think that the most important element to make the exercises helpful is that you be as relaxed as possible when doing them. You have to find your own comfort level in doing them. I found that in my own case this meant doing the exercises late at night at home on my rug was the most relaxing way for me to do them.

I will not describe the three exercises that I do, because each of you has your own physical regimen to do. There are days in which I only do about one-third of the prescribed amount either because of physical pain that I am in, or because I am not mentally prepared to do them on a particular day, for whatever reason. Every once in a while, I will pass on doing the exercises that day, and even though I do feel guilty for not having done them, I feel that is best for me on that particular day to do none. Most of the days I do the exercises faithfully, and feel more than anything else, this is what has been able to keep my pain level down in the very manageable level of 1-2.

(1/24/05)- The following is an email that we received here at therubins in which the possibility is mentioned between Cipro, the anti-biotic exacerbating the spinal stenosis condition.

In our article which relates what happened to me, I discuss the fact that I was given Cipro to treat the diverticulitis that was discovered when I took an MRI in October 2001. I had already been suffering from a high level of pain at that point, but my pain level did continue to worsen in the ensuing months. Did the Cipro have anything to do with this worsening pain level? I do not know.

Upon receipt of this email, we at therubins decided to ask our viewers if any of them experienced a similar situation. We obtained permission of the writer of the email to publish the question, but we did agree to omit the name of the author of the email. We are not scientists or medical professionals. We would however appreciate your emailing us if you experienced a similar increase in pain level after taking Cipro. Her is the email in question"

Hi;
I surfed onto your page while researching a possible connection between Cipro and spinal stenosis.

I too was given Cipro for diverticulitis and since then I have developed various neurological problems and had various ligament/muscle pains as well. Prior to Cipro I led an active life.

I'm just a regular person and I am trying to figure out what went wrong. I only just found out I have spinal stenosis in my neck area. I just got the MRI report, last week.

Please, if you have time and are willing, could you look up some websites which have helped me too - If you want to go through Google that's fine. Again I'm just a regular person trying to find some answers. Some of the websites outlining how dangerous Cipro and other FQ antibiotics can be, are: www.fqresearch.org, www.fqvictims.org

Basically I am trying to figure out if the Cipro may have caused or worsened my stenosis. Cipro can and does (re: FDA report) cause permanent nerve damage, narrowing of arteries and permanent connective tissue damage. When I read your page and it described how you were once very active and now consider climbing bleachers an achievement, it sounds just like me now. Just getting around is an achievement now and not something I can do every day.

Any insight either way is very welcomed. Thank you !!

Signed (name deleted)

(12/8/04)-It is now 5 months since I got my spinal steroidal cortisone shot in July. Please keep in mind that I had gotten 2 spinal steroidal cortisone shots in July of 2002 also. I am back to taking Neurontin-300-mg, once a day. Whether it is mental or physical, I am not sure, but just the fear of having the full pain from the spinal stenosis return is enough to keep me on the pill. Last Saturday I was able to take a long, long walk with only relatively little pain to impede me, so I am now going to stay on the one-a-day regime for a while. At worst the pain only rises to about a 3 level which is no problem, but the fear of it going back to the 10 level is still with me.

When I ordered my refill from Medco Health Services, which is the prescription benefits manager used by my employer through whom I must re-order my medication, I was advise that the prescription had been changed to gabapentin from the Neurontin as called for in the prescription.

When my physician wrote the prescription for Neurontin he checked the box that allowed the pharmacy to substitute a generic version of this drug if one was available. I have no objection to the substitution whatsoever. Under my company's prescription drug plan, I pay $35 for the prescription instead of the $70 as my co-payment, since the cost drops if a generic is used as a replacement for the brand name drug. I will keep you posted if I notice any difference when I take the generic drug instead of the brand name drug.

(10/16/2004) Alpharma said that a federal appeals court had lifted an order blocking it from selling a generic version of Neurontin, which is Pfizer's 4^th largest selling drug. The ban was issued in July 2004 after Apotex challenged Alpharma's right to six months of market exclusivity for gabapentin, the curcial ingredient in the medicine. Apotex would like to be able to sell its own generic version of the drug. Alpharma and Pfizer had reached an agreement that allows Alpharma to sell its generic version of the drug. Apotex's appeal of this ruling is set for a hearing on December 6, 2004. Please keep in mind that the prescription drug health insurance companies will not cover a generic version of a drug, while they do cover the brand name version of the drug.

It is now almost five months since I cut down on the usage of Neurontin from two 300-mg capsules a day to one 300-mg capsule a day with no increase in my level of pain. As a matter of fact I have actually reduced my intake of the drug to skipping taking it at all every third day. So far so good! Neurontin is prescribed as an anti-seizure medication, and so most of its usage has been for off-label purposes. I still skip taking the drug every third day, and have not changed this routine because of the mental fear within me that the pain will return. Again I do not know if the Neurontin helps, but the memory of the pain level is so great that the fear of its return is still prominently in my mind.

Ivax Corp. has introduced its generic version of Neurontin called gabapentin, which is in tablet form as opposed to the capsule form that Neurontin comes in. Pfizer is also introducing its next generation of the drug called Lyrica, and is presently trying to get FDA to approve the drug. Lyrica, also known by the name of pregabalin, was approved in Europe as a pain and seizure medication in July. The FDA has given Lyrica the "approval" for treating the pain from nerve damage caused by diabetes, for a painful side effect for shingles, and as a treatment to cut down on seizures in epileptics.

Well I almost made it to the two-year mark before I needed to get another steroidal cortisone shot for my spinal stenosis. On July 2, 2004 I got what thus is the third one of these shots, with the first one having taken place on July 13^th 2002. The administration and procedures for the shot was exactly the same as I wrote about later in this article.

This time the pain was emanating from my right buttock area and was a dull pain rather than the extremely sharp pain in the left leg area that I wrote about earlier. This dull pain did not occur when I was walking but only took place after I was sitting for about 1/2 an hour. The pain would disappear if I stood up and walked around for a minute. The only time that this was truly a problem was when I was driving my car for a longer length of time.

I went to my orthopedist who had x-rays taken of my pelvic area. The x-rays showed no broken bones so he once again referred me to the same pain management doctor that I had used for my earlier problem. That doctor had me take an MRI. The MRI showed that I had some compressed discs in my lower back, and also some slightly herniated discs in the lower spine. I have been told that herniated discs are a leading probable cause when pain arises as a result of sitting.

I took the shot on July 2, 2004 and it should take between 3-5 days before I can tell if it is helping me. I have learned from my earlier experiences with the shots to give it an even longer period of time to see if it is working.

About two months ago I cut down on my intake of the Neurontin to one 300-mg pill a day from the original amount of three pills a day. So far I am doing just as well on the one pill a day regimen as I was doing on the two pill a day regimen. I am not having any major problem with my left leg. I would judge the pain level in the left leg as between a 2 to a 3 so it really is not a problem.

On May 15, 2003 I went to a Yankee game at the Stadium and I sat in Row V, Section 3, Upper Deck Reserved. I will not forget that day for the rest of my life. That row is second from the top of the upper deck at Yankee Stadium. Pre-spinal stenosis I never would have even given a second thought to what an accomplishment it was to climb to that level of the stadium. Post-spinal stenosis I have learned to appreciate all the simple physical accomplishments that I had never even given it a thought about before.

The big question in my mind deals with the taking of the300-mg dosage of Neurontin. I am using it for off-label purposes, since the medication is approved mainly for epilepsy. Although my doctor has told me that I can take the medication for a prolonged period of time, I am not a "happy camper" to be taking any extra medications. Please keep in mind that the original prescription called for taking the drug three times a day.

Incidentally, Teva Pharmaceutical Industries of Israel announced that the FDA had tentatively approved its generic version of Pfizer's Neurontin. Annual sales of Neurontin were about $2.7 billion worldwide in 2003, with about 85% of the sales being made for off-label usage. Analysts expect generic versions of Neurontin to become available early next year. The drug has been prescribed to about 10 million patients since it was introduced in 1994.

I realize that taking steroidal cortisone shots is not good for the rest of the body's system, but as anyone who has this disease can tell you, it is a very painful disease. A petition has been filed with the FDA,by a personal-injury law firm, Finkelstein & Partners (Newburgh N.Y.), asking that the agency act on claims that the Neurotin may be tied to suicidal behavior. The law firm has filed three lawsuits against Pfizer on behalf of people who committed suicide or attempted it while on the drug.

The petition is based on the agency own adverse-event reporting database, and it asks that the FDA require the company to add a suicide risk item on its label for Neurontin. According to the petition, the number of suicides reported by Pfizer to the FDA jumped to 17 in the first 6 months of 2003 compared with a total of 8 reported in 2002. In a statement, Pfizer said it remains "confident of the safety and effectiveness of this product".

I have received several e-mails from readers so that I have gained some additional knowledge about the disease. In my own particular case if the shots did not work, the next step would be a nerve blockage procedure. Incidentally several of you have written to say that the insurance carriers, Medicare and Medicaid have taken a very long time to approve the nerve blockage procedure for coverage. The problem seems to be that there is no assurance that the nerve blockage procedure will work. I do not have any statistics to indicate what the success rate is for the nerve blockage procedure, but the fact seems to be that there is no guarantee that it will work. As will all know, when you are in great pain you are willing to try anything.

Spinal stenosis refers to the narrowing of the spinal canal, nerve root canals or intervertebral foramina due to spondylosis or in plain English, degeneration due to aging. Believe it or not, I had never heard of the disease until I became a victim of it myself. One of the purposes of our site is to help older people and their loved ones gain additional knowledge about their problems, and how through knowledge, they can better deal with those problems. I am almost 71-years of age and have always been in excellent health. The only time that I had spent in a hospital besides a few experiences in the emergency room had been when I had an ambulatory operation for a hernia 5 years ago. In that procedure you do not even stay in the hospital for one day.

There is an interesting book that has been written by Dr. James N. Dillard with Leigh Ann Hirschman (Bantam Books, $24,95) which deals with the topic of examining different alternatives to help you manage and soothe chronic pain. The name of the book is "The Chronic Pain Solutions: The Comprehensive Step-by-Step Guide to Choosing the Best of Alternative and Conventional Medicine". Dr. Dillard is on the faculty of Columbia University College of Physicians and Surgeons and at the University Pain Center in Manhattan. He is a medical doctor, an acupuncturist and a chiropractor.

He writes that "Chronic pain does more than hurt, it takes control over the way you live." Chronic pain in some form or other affects more than 50 million Americans. It ranks third as a health problem in the United States behind heart disease and cancer. The book examines the best of what Western medicine offers along with alternative therapies, such as diet.

The book deals with pain that arises from all levels such as from migraine headaches to neural disorders. He discusses and agrees with the usage of painkillers if needed, but he also devotes a good portion of the book to getting the pain under control with as few drugs as possible or none at all.

In this article I will continue to update you about my problem with spinal stenosis, and how my treatment is evolving. I will not name any of the physicians or hospitals involved in my treatment.

I would rate my pain level in my left leg and groin area at the 2 1/2-4 1/2 level, with a 10 being the highest level of pain. From this evaluation you can see that I therefore am rating my pain level as manageable. Although I do realize that the steroidal shots will wear off at some point, and that the pain level will increase, I am quite comfortable with living with that thought in the back of my mind. I can walk very long distances again, with no problem at all. I have now resumed all of the physical sports such as tennis that I played before the problem arose.

I can not say with any degree of assuredness that it is the Neurontin that is helping me accomplish this comeback. I have now reduced the Neurontin to taking it only once a day and so far the pain level has not increased to any great degree. I do not know that staying on the Neurotin is entirely "safe", but I have experienced the pain that stenosis can bring on me, and I can do without that "pleasure" very nicely thank you. The foot doctor and the pain management doctor both have advised me that, to the best of their knowledge, I can stay on the Neurontin for a long time without it having any major negative effect on me. I have experienced a slight level of nausea lately but it is not too bad a problem.

As of this date I have some pain in my left leg, and I have had some pain in the groin area around my right leg. I have been taking Neurontin, as was prescribed for me by the physician who examined my left leg in connection with the pain from the tibialis muscle and sural nerve that I discuss later in this article. I can do physical exercises and walk because the pain is not that bad. I am aware of the fact that Neurontin is approved for epilepsy, and its usage in connection with my pain problem from the sural nerve is an off label-usage. Yes I do worry about its safety, but when one has excruciating pain as I did have, I had to have something that would help alleviate the pain.

I received my first steroidal cortisone shot on July 13^th 2002 and my second shot on July 31^st 2002. There were 2 different times right after having gotten the second steroidal injection when I did have a high enough level of pain that I did set up an appointment for the nerve blockage procedure. In both cases the procedure was set up to take place two weeks after I had called it in. I was therefore able to postpone them both times since the pain level decreased to manageable levels in the interval before the procedure was to take place.

Someone I know who also has spinal stenosis told me that the H.M.O that he belongs to has denied his application to have the nerve blockage procedure done on him. He has appealed the decision, but unfortunately, the process is taking months to evolve even though he presently is in great deal of pain. As of this date that individual still has not received the needed approval for the procedure from his H.M.O.

In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. In most cases this results in lower back and leg pains. I never did encounter any lower back pain at all, but in its latter stages I did have a great deal of pain in my left leg when I walked or sat down. The primary causes of spinal stenosis are heredity and aging. To the best of my knowledge I think my problem resulted from aging rather than from heredity. The disease is sometimes referred to as lumbar stenosis also.

A little over four years ago I began to encounter a slight stinging pain in the area around the inside of my left femur bone. At the time I even thought the pain might have been coming from the left groin area itself. The pain was intermittent and I thought that it might be the reappearance of the hernia problem. I mentioned it to my physician and he sent me to be checked out for the possibility of a hernia. I was examined and it was diagnosed as not being a hernia problem.

I ignored the problem for a while since it was not that painful a situation. As time passed I began to get a pain in the outside area around the left femur bone as well as in the inside area around the same bone. My physician then sent me for a MRI, which took place about October of 2001. The MRI revealed that I had diverticulitis. I was treated for the diverticulitis with the anti-biotic Cipro for 10 days. MRIs can reveal spinal stenosis although no such determination was made in my case.

The pain then began to extend to the exterior area around my left kneecap as well as the some other areas of the left leg. I also was experiencing a great deal of pain in my left tibialis anterior muscle and all my left leg toes except for the big toe were slightly swollen and not readily flexible. In the following months I also went to see a vascular doctor, and also a neurologist all to no avail.

I was told to take it easy and not do as much exercise and walking as I have been accustomed to doing. I have been an avid exerciser and walker all my life. As an example I walk to and from work every workday no matter what the weather is for many, many years. I will walk to wherever I have to go to in the city, never using public transportation because I love walking so much. At this point I will add that I never did stretching exercises before I exercised or played ball and that was a big mistake on my part. I now do my basic stretching exercises every day and feel that they have helped alleviate my problem somewhat.

My pain continued to worsen so that by June 20, 2002 I could no longer walk to work. I went to an orthopedist who x-rayed my spine and determined that the discs in my lower spine were compressing leaving very little room between the discs.

I was given several stretching exercises to do that might help with the compression of the discs in the lower spine. I also went for a CAT scan, and it was determined that I had spinal stenosis. By this time I could not walk more than 25 feet without having to stop so that the pain could abate. I decided to try acupuncture also because as we all know when you are in pain you will try anything that might help alleviate it. Ultimately I went to 4 sessions with the acupuncturist. The acupuncture did not help my problem.

My orthopedist referred me to a pain management specialist who gave me an epidural steroidal injection. My epidural steroidal injection consisted of a cortisone injection in the epidural area in the lower spine, which is the area that surrounds the spinal cord and the nerves coming therefrom. The injection is intended to reduce the swelling and/or inflammation of the nerves in that area. If the first injection does not help relieve the pain you can try having a second shot a few weeks later in the hope that the second shot will do the trick. Three cortisone shots within a 6-month period of time is the maximum that the physician would administer to me.

I was given the first shot in the pain management doctor's office on July 13, 2002. I sat up on the doctor's table and he then administered a local injection to the area near my spine somewhere between the mid to lower back. The purpose of that injection was to numb the area preparatory to the steroidal injection. A minute or two later he administered the steroidal injection very close to my spine, after having felt the spine to ascertain exactly where he wanted to inject the needle. That whole procedure lasted 5 minutes at most. After he had finished I was told to lie on my side, on the table for 15 minutes and rest. I felt no pain from the procedure whatsoever, and I was able to leave his office and take the train to work.

I estimated that my pain was about 90% gone after the injection. Two weeks later on July 31, 2002 I was given a second steroidal injection since I did continue to feel some pain in my left leg. I was able to walk to work after having rested for a short while after underging the same procedure as I described above. I went for physical therapy for a two sessions thereafter and I now do stretching exercises daily.

Thereafter I went to see a physician, who specializes in legs, since I still had some pain in my left tibialis anterior muscle, pains emanating from my left sural nerve and swelling in my left foot by my toes. The doctor prescribed Neurontin, which is a drug that is usually used in connection with epilepsy. In my case the Neurontin hopefully would relieve the pain in the leg. I was to take the Neurontin (300-mgs) three times a day.

It is difficult to tell whether or not the injection will work in all cases and the extent of pain relief if any that it will afford. The injection will gradually wear off, and there is no telling as to how long it will be good for even if it works. A maximum of 3 injections is recommended at most in a 6-month period of time.

As far as I am concerned I am quite happy to be walking again. My pain management doctor had told me that if the shot did not work, the next step would be a nerve blockage procedure that is done in the ambulatory surgery area of the hospital. I have read that there may be some side effects as a result of the shot such as weight gain, increase in blood sugar level on a temporary basis, water retention and suppression of the body's own natural production of cortisone. I have not had any or these negative effects so far.

We recently received an email from Emily Schultze, the marketing associate for a site named www.spine-health.com requesting a linkage from our site to theirs. We visited their site and found it to be really terrific in regards to information about back and spinal pain. We highly recommend your taking a look at this site.

Spinal Stenosis-Clinical Trials- Part II
Spinal Stenosis- What has Worked or not Worked for our Viewers- Part III

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"

By Allan Rubin
updated February 28, 2008

http://www.therubins.com

e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com

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