Patients prefer relief from lower back pain over improved mobility


A new study published in Neurology has found that when asked to choose between treatments that reduced pain or those that would help them stand or walk, lumbar spinal stenosis 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, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery, Rochester, USA, 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.”

There is compelling evidence that surgical treatment of lumbar spinal stenosis provides relief and improves mobility by decompressing affected nerve roots, 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%) 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 mailbox 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. Levels of pain relief have largely been left as the responsibility of pharmaceutical company scientists and government officials, 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 prioritise 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.