A new study out today in the journal Neurology examines the question of quality of life for individuals with a common form of lower back pain called lumbar spinal stenosis. The findings show that, when asked to choose between treatments that reduced pain or would help them stand or walk, patients overwhelmingly chose pain relief.
"There has long been a debate in the medical community over striking the right balance between pain relief and physical function," said John Markman, M.D., director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery and lead author of the study. "While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief."
Lumbar spinal stenosis is brought about by a narrowing of the spinal canal caused by the degeneration of the vertebrae, discs, joints, and ligaments that comprise the spinal column, resulting in a compression of nerve roots. This narrowing of the spinal canal triggers pain, tingling, and numbness in the lower back, buttocks, and legs which is most commonly experienced when a person is upright or walking.
There is compelling evidence that surgery provides relief and improves mobility, however many patients outlive this benefit or are not candidates for surgical treatment. Epidural steroid injections also may provide short term relief of pain.
Researchers surveyed 269 patients with lumbar stenosis with chronic back pain and difficulty standing and walking. The researchers asked patients about their priorities, specifically, whether they prefer a treatment that reduced their pain or one that would allow them to walk further. The study participants overwhelmingly (79 percent) chose reduced pain over improved mobility - no matter how much the condition impaired their ability to stand and walk.
"Even the patients who could not stand long enough to pick up a letter from their mail box or wash the dishes after dinner chose pain relief," said Markman.
This research is an example of the new standards for pain relief that are being created based on input from patients. To a great extent, levels of pain relief have been left to pharmaceutical company scientists and government officials to decide, often with little guidance from patients. There is now a growing demand that new generations of pain medications are not only safe, but meet patient's expectations for pain relief.
The most common study populations for these newer drugs are patients with chronic low back pain. Many experts are arguing that new pain relievers, especially those with greater risks like opioids, should not just relieve pain but also improve patients function such as their ability to walk. This new study calls into question those assumptions.
"This study convincingly demonstrates the need to prioritize pain relief because that is what patients want," Markman said.
Additional co-authors include Jennifer Gewandter, Maria Frazer, Babak Jahromi, Christine Pittman, Xeuya Cai, and Robert Dworkin with the University of Rochester, John Farrar with the University of Pennsylvania, and Kushang Patel with the University of Washington.