What the New 2026 Lumbar Spinal Stenosis Study Means for Patients on Pain Meds

By Dr. Jason Forward, DC. Practicing chiropractor in Tulsa, Oklahoma. Posted April 16, 2026.

What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis (LSS) is a narrowing of the spaces inside your lower spine. The spinal canal in the middle holds your spinal cord. The smaller side openings, called foramina, are where nerve roots exit. When those spaces shrink because of arthritis, disc changes, or thickened ligaments, the nerves get crowded.

The classic story sounds like this. A person in their sixties or seventies notices their legs get heavy, achy, or weak after walking a block or two. Sitting down or leaning forward over a shopping cart makes it better. Standing tall makes it worse. That pattern is called neurogenic claudication, and it is the hallmark of LSS.

It is one of the most common reasons older adults end up in spine surgeons' offices. It is also one of the leading drivers of long-term prescription painkiller use in the over-60 population. That second point is what makes the new 2026 study so important.

Why Painkiller Use Around Stenosis Matters

Most people with stenosis are managed with some combination of:

• Acetaminophen (paracetamol)
• NSAIDs like ibuprofen, naproxen, or meloxicam
• Gabapentinoids like gabapentin or pregabalin for nerve symptoms
• Opioids when other options fail or are not tolerated
• Epidural steroid injections
• Surgery (laminectomy, decompression, fusion)

The problem is that long-term use of any of those medications carries cost. NSAIDs cause stomach bleeding and kidney strain in older adults. Gabapentinoids cause sedation and falls. Opioids cause dependence, constipation, cognitive fog, and dramatically higher risk of fatal falls in seniors. Even acetaminophen, the safest of the bunch, has liver risk at higher doses.

So when researchers can show that a non-drug intervention is associated with patients filling fewer of these prescriptions, that is a meaningful clinical finding. It is also a finding that almost no one in the United States is publishing about chiropractic care for stenosis. The Danish chiropractic research network has been quietly building one of the strongest real-world datasets on conservative spine care anywhere in the world. This study is a piece of that.

What the Study Actually Found

The full citation is Jensen RK, Bech M, Skovsgaard CV, Ryg J, Hartvigsen J, Johansson MS. Use of prescribed analgesics before and after a standardised chiropractic care programme among patients with lumbar spinal stenosis: a nationwide cohort study. Chiropractic & Manual Therapies, April 14, 2026. PMID: 41975434.

Here are the numbers in plain English.

The Core Finding

About 45% of patients were filling prescriptions for analgesics in the 12 months before they started a standardised chiropractic care programme for stenosis. Use went up during the active care period, then declined afterward. That pattern is consistent with what we see clinically. People often need a temporary bridge of medication while they get through the early weeks of treatment, then reliance falls as function returns.

The Concentration Finding

The researchers used Lorenz curves and Gini coefficients (statistical tools borrowed from economics, where they are used to measure income inequality) to look at how painkiller use was distributed across patients. They found extreme concentration:

• The top 10% of users accounted for 43% of all paracetamol use
• The top 10% accounted for 49% of NSAID use
• The top 10% accounted for 68% of opioid use
• The top 10% accounted for 57% of gabapentinoid use

Translation: most stenosis patients use modest amounts of painkillers. A small group uses the vast majority of the most addictive and risky drugs. That changes the conversation. Population-wide deprescribing strategies need to focus on the high-use minority, not on average patients.

The Risk Factor Finding

Using modified Poisson regression, the authors identified factors that predicted continued analgesic use after the chiropractic programme:

• Female sex: 5 to 16% higher risk of continued use depending on the drug class
• Comorbidities: more chronic conditions, higher risk
• Prior opioid use: strong predictor of staying on opioids
• Prior gabapentinoid use: strong predictor of staying on those drugs
• Long-cycle higher education: 13% lower risk of continued use

That last one is interesting. Higher education is a known proxy for health literacy, social support, and ability to navigate complex care. None of those are pharmacology. They are about how patients engage with their treatment.

What It Means in Practice (From My Chair in Tulsa)

I see lumbar stenosis patients regularly at Vanguard Chiropractic. Most have already been told they need surgery, or are quietly dreading the day they will. Many are filling monthly prescriptions for gabapentin and either an NSAID or a low-dose opioid. They want to avoid the operating room. They want to avoid the pill bottle. They are stuck.

This study lines up with what I see in practice. A meaningful chunk of these patients can reduce reliance on painkillers when they get consistent, conservative manual care combined with movement work. The mechanism is not that an adjustment opens up the spinal canal. It does not. The mechanism is that improved segmental motion, calmer surrounding muscles, and better hip and thoracic mobility take pressure off the system. The nerves still live in a tight space. They just stop screaming as much.

Here is what I tell new stenosis patients in my Brookside office:

1. We are not curing your stenosis. The bony narrowing is structural. We are addressing the soft-tissue and motion-based contributors that make a tight space feel even tighter.
2. Most patients feel a real difference within four to six visits. If you do not, we have an honest conversation about whether to keep going.
3. Hip mobility, thoracic extension, and core endurance matter more than a single adjustment. We work all of them.
4. If your pain is getting worse, your legs are getting weaker, or you are losing bowel or bladder control, you go to the ER. Today. Not next week.

That last point matters. Stenosis can rarely progress to cauda equina syndrome, which is a surgical emergency. Anyone offering you chiropractic care for stenosis without screening for red flags is doing you a disservice. For more on the difference between mechanical pain and red-flag pain, see my breakdown of pinched nerves and when chiropractic is appropriate and when surgery for a disc actually becomes necessary.

What This Study Does NOT Show

I want to be straight about the limits of this research, because the AI summaries and the press releases will not be.

It is observational, not a randomized trial

The study tracked what happened to patients in real-world Danish chiropractic care. It did not randomly assign half the patients to chiropractic and half to a sham. That means we cannot conclude that chiropractic caused the drop in painkiller use. Patients who choose conservative care may differ from those who do not in ways the data cannot measure. Maybe they were already trending toward less medication. Maybe their pain was naturally improving. Observational data shows associations, not causes.

It uses Danish prescription registry data

The Danish system is a registry-based gold mine. Every prescription is recorded centrally. That is great for accuracy but it has limits. The data captures what was filled, not what was actually taken. A person can fill a bottle of gabapentin and never swallow a pill. The data also does not capture over-the-counter use, which matters in Denmark just like in the US.

The Danish system is not the US system

In Denmark, chiropractic is partially funded by national health insurance and integrated with primary care. In the US, chiropractic is mostly out of pocket or on partial commercial coverage. Patient demographics, prescribing culture, and access patterns are different. The size and direction of the effect found in Denmark will not necessarily replicate exactly in Tulsa.

The study cannot prove chiropractic "treats" stenosis

The authors are careful and so am I. This study reports analgesic use patterns. It does not measure pain levels, walking distance, MRI changes, or surgical avoidance directly. It is a piece of a larger evidence puzzle, not the final word.

Conflicts of interest exist

Two of the authors are affiliated with the Chiropractic Knowledge Hub, a Danish chiropractic research organization. The authors disclose this openly in the paper. Disclosure is not the same as bias, but informed readers should know.

The authors themselves wrote, in their conclusion, that the findings "highlight the complexity of analgesic use in this population and emphasise the need for deprescribing strategies that take this complexity into account." That is a careful statement. It does not say chiropractic is the answer to the opioid crisis in older adults. It says the picture is complicated and one-size-fits-all approaches will not work.

What This Means for Tulsa Patients With Stenosis

If you are in Tulsa and you have been diagnosed with lumbar spinal stenosis, here is the honest framework I would give you.

Conservative care should be your first stop, not your last

Most clinical guidelines for stenosis recommend conservative management before surgery is considered, except in cases of progressive neurological deficit. Conservative care includes physical therapy, chiropractic, exercise, weight management, and judicious use of medication. There is no good reason to skip this phase.

Define a trial period

Pick a defined window of conservative care and judge it on results. In my practice, four to six visits is usually enough to know whether we are moving in the right direction. If your walking distance improves, your morning stiffness eases, or your medication needs drop, we are on the right track. If nothing changes after a fair trial, we say so out loud. For more on the timeline question, see how long a chiropractic adjustment takes to work and how often you should see a chiropractor honestly.

Combine modalities

The strongest results I see in stenosis come from people who do more than one thing. Adjustments plus targeted exercise. Adjustments plus walking practice. Adjustments plus soft-tissue work like Thai bodywork. My wife Nahla runs Stretch Haven in our same office, and we send patients back and forth all the time. Combination care works better than any single intervention alone.

Know the red flags

Conservative care is not appropriate when stenosis is causing rapidly worsening leg weakness, foot drop, saddle anesthesia, or new bowel or bladder problems. Those are surgical signs. Get to an ER or your spine surgeon. For background on when chiropractic is and is not appropriate, read my honest breakdown of chiropractic safety and when to see a doctor instead of a chiropractor.

Compare your options on cost and access

Conventional pain management for stenosis often runs hundreds to thousands of dollars per month between specialist visits, injections, and prescriptions. At Vanguard Chiropractic, every visit is $40. No insurance billing, no packages, no pressure. That makes a meaningful trial of conservative care affordable even on a fixed income. See how chiropractic cost compares in Tulsa and our walk-in model.

Compare chiropractic and physical therapy

Both have a role in stenosis. They are not the same and they are not in competition. I lay out the differences in chiropractor vs physical therapy. Many of my best stenosis outcomes come from patients doing both at the same time.

Understand why pain comes back

Stenosis is not a one-and-done injury. Symptoms wax and wane based on activity, posture, and overall conditioning. Patients who understand why back pain keeps coming back and why sciatica keeps returning tend to manage the condition long-term better than patients who chase one-shot fixes. Knowledge of what an adjustment actually does mechanically helps you set realistic expectations too.

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