Exercise, oral NSAIDs, and serotonin and norepinephrine reuptake inhibitors (duloxetine) were shown in a systematic review to produce a clinically meaningful reduction in pain, with exercise being the only intervention that demonstrated sustained benefit after the intervention ended.
A 2021 meta-analysis comparing fusion and nonfusion surgeries for lumbar spinal stenosis found no difference in clinical effects and complications, highlighting the challenge of surgical intervention for lumbar spinal stenosis.
A 2020 Cochrane review of 25 placebo-controlled trials provides moderate-quality evidence that epidural corticosteroid injections are effective, although the treatment effects are small (mean difference < 10%) and short-term for improving radicular pain for individuals.
There is level I evidence for the use of transforaminal injections for radicular pain from disk herniation.
The first-line recommendation for pain management is topical nonsteroidal medication.
Alternatively, topical capsaicin may be effective.
Acetaminophen has been shown to be less effective than NSAIDs but can be used in patients when NSAID use is contraindicated.
Tramadol can be used appropriately in patients with severe OA as alternative to NSAIDs, while opioid use is now discouraged.