Spinal stenosis is closely associated with degenerative arthritis of the spine, and can be very difficult to live with. As with many other back and neck conditions, diagnosing it early can help manage it successfully over time.
But the diagnosis process is not always straightforward. According to Dr. Mark Ebell, Senior Editor of Essential Evidence Plus, a website that helps clinicians make evidence-based decisions, spinal stenosis "is a tough diagnosis to make".
In an Essential Evidence Plus POEM, Dr. Ebell summarized and commented on a 2010 systematic review of medical literature that looked to what degree specific symptoms (age, bilateral leg or butt pain, pain in certain positions, etc.) correlated with a diagnosis of spinal stenosis.
Interestingly, the reviewers were only able to locate 4 studies (involving 741 patients total). Based on the fact that spinal arthritis is one of the most common types of arthritis (and arthritis is the leading cause of disability in the US), you would think the PTB would have arranged for more studies on diagnosing the stenosis that often results from it....
Anyway, the reviewers found that age (greater than 70 years), pain with walking, neurogenic claudication, bilateral butt or leg pain, unexpected urinary problems, no pain when sitting and pain relief when bending forward all correlated with a diagnosis of spinal stenosis, and most of them quite highly. These signs and symptoms were obtained from the patients in the studies during the medical histories. Their physical exams revealed that people who use a wide stance as their regular posture were more likely to have stenosis, as well.
This review also found that being younger than 60 and the absence of neurogenic claudication were correlated with not having spinal stenosis.
Sources:
Ebell and Wilkes. Useful signs and symptoms of lumbar spinal stenosis. Poem of the Week Podcast #154 Essential Evidence Plus. Accessed 5/15/12.
Pradeep Suri, MD; James Rainville, MD; Leonid Kalichman, PT, PhD; et al. Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis? The Rational Clinical Examination JAMA. 2010;304(23):2628-2636
Sadly, the American Pain Foundation closed its doors last week. I received the following in an email, and it seems that pretty much all the content on their website has been replaced with it as well:
With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately. On May 3, 2012, the Board of Directors formally voted to dissolve the organization.
The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts.
APF hopes to be able to transfer content from various information, education, and support programs to other organizations so that you may continue to benefit from the value these programs have provided to thousands of individuals and families across the country.
Your personal experiences in living with pain and seeking compassion, empathy and medical care often against the odds -- have driven our efforts over these many years. This includes enactment of key provisions of the National Pain Care Policy Act in the Health Reform Bill that led to a landmark report issued in 2011 by the Institutes of Medicine. This report documents the shocking numbers of US citizens that live with pain and calls for immediate changes to address gaps in care. Despite this, the current climate towards improving the plight of people with pain in the US continues to be precarious and hostile.
As you unfortunately know, the need for public outcry around the needs of Americans struggling with pain conditions is greater today than ever before in light of the multi-front assault occurring daily on our right to dignified care. Misguided state and federal policies are impeding access to appropriate and reasonable medical care for people struggling with pain, and deterring even the most compassionate medical providers from treating anyone with pain conditions.
It is therefore critical that each of you raise your voices singularly and together to demand the care you deserve. It is only by continuing to demand attention to the ever-worsening barriers and unacceptable suffering that change will occur.
Elected officials, policy makers, and the media need to keep hearing from each and every one of you so they are not allowed to walk away from the consequences of this over-looked public health and medical problem.
Please know that although APF will cease to exist, the resolve and commitment among individuals on the Board and staff remain strong.
While a crick in the neck generally doesn't require a doctor's appointment, few people can deny the intense discomfort they feel when they have one. So what do you do? For starters, you might try some at home therapies. If that doesn't work, maybe it is time to see a doc.
