Q: I am an 88-year-old woman with spinal stenosis and osteoarthritis. I can hardly walk, for the pain is severe. I am taking Vicodin and have an upset stomach and constipation from the medication. However, when I skip my dosage, I stay in bed for I have no ability to walk. What shall I do, for surgery is not an option?
A: Spinal stenosis places pressure on both the spinal cord and the nerves within the spine. The condition is most commonly the result of the aging process and is actually referred to as “wear and tear” that causes the spacing between the spine to compress. Other causes of pressure on the nerves in the spinal canal can be the result of a herniated disc, bone spurs, injury, a thickening of the ligaments, and more. A herniated disk is a pushing in of the disk in the spinal space that sometimes can push into or herniate into the space to the point where it can press on the nerves. Spurs can grow into the spinal canal and cause pain. Injury can be the result of an automobile accident, fall, or other trauma to the back and may result in a dislocation or fracture of the vertebrae. Ligaments can thicken, become stiff, and bulge into the spinal canal as we age.
Symptoms of the nerves being impinged in the neck may include neck pain with weakness and numbness that results in tingling of the extremities. When it occurs in the lumbar area (lower back), the compression can cause pain, leg cramps and tingling following standing for extended periods of time.
Treatment might begin with over-the-counter nonsteroidal anti-inflammatory drugs to relieve some of the pain and inflammation. If you suffer from muscle spasms, muscle relaxants might help. The progression might go on to anti-seizure medications, anti-depressants and to stronger drugs that, as you have discovered, can cause constipation, stomach upset and other unwanted side effects. Under your physician’s guidance, a physical therapist might teach you gentle exercises to help with balance and strengthen your back. And while you cannot have surgery, you might consider asking about steroid injections to the site that might reduce symptoms. Hot and cold packs to the area, acupuncture, chiropractic and even aromatherapy might reduce your pain level. Your constipation might even be helped by taking a stool softener or other medication recommended by your physician.
Osteoarthritis is a chronic disease of the joints that results from a cartilage breakdown. With this condition, the cartilage that cushions the ends of the bones that form the joint degenerates. Healthy cartilage is smooth, flexible, and elastic, allowing for easy movement, yet when an individual suffers from osteoarthritis, the surface of the cartilage softens, becomes pitted, frayed, and cracked. With progressive breakdown, the ends of the bone thicken and spurs form at the point where ligaments attach to the bone. The ligaments themselves may thicken. Bits of bone and cartilage may float in the joint space, contributing to pain on movement.
Symptoms vary from person to person but they generally begin slowly with mild aching and soreness. There may be a limited range of motion, creaking and inflammation. Pain may be present even when an individual is at rest and implies that joints have either been over-used or are kept motionless for extended periods, such as occurs when a person is bedridden.
Treatment may include medication, rest, mild exercise and protection of the affected joint(s). Acetaminophen and ibuprofen are widely used for reducing pain and inflammation. When these over-the-counter nonsteroidal anti-inflammatory drugs fail to provide relief, corticosteroid injections directly into the affected joint(s) may help relieve pain. Moderate exercise is vital as a means of maintaining flexibility of the joint(s) as well as mobility. Yoga or water aerobics at a community center are endorsed, as is physical therapy. I can appreciate that exercise may be difficult for you with the amount of pain you experience, but there are a number of maneuvers that can be accomplished while sitting in a chair. Arm and leg raises can be learned from a physical therapist or from a senior balance program. Ask a family member or neighbor to investigate possibilities near your home. Walking is good. It need not be brisk but the movement will strengthen you and provide relief.
Begin by speaking with your physician to determine any limitations you may have. Review your dietary intake to determine if a one-a-day vitamin or a calcium with D supplement is advantageous and ask about a steroid injection. Allow him or her to set you up with your local hospital’s physical therapy department. Using moderation, exercise from home. Walk around your yard. Eat well and above all, stay active.
Readers who would like related information can order Dr. Gott’s Health Report “Osteoarthritis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
