Brief Answer:
Depends upon the cause

Detailed Answer:
Good evening. Arachnoiditis simply stated is an inflammatory process of the meningeal layer that covers the brain and spinal cord. It is the middle of 3 layers which takes its name from its structure which is "spidery" as the thin membrane invests itself into every nook and cranny of the brain and spinal cord so to speak. When the layer is dissected away carefully it's almost hard to believe that there is still 1 MORE layer which lies below called the PIA MATER.

At any rate, this middle layer of the meningeal covering can get inflamed or swollen or irritated by a number of ways. One would be infection which could be viral or bacterial. Another would be by traumatic means which can happen due to penetrating or even blunt trauma injuries such as projectiles, concussive forces which can cause tearing/shearing of the layer, surgery which actually CUTS through the layer, and then, there are miscellaneous types of things such as immune system attacks, cancerous infiltrations including tumorous growths, and bleeds which will cause inflammation by way of compression as well as chemical irritation.

In short the TREATMENT depends entirely upon the CAUSE. Make sense? So, if we know what is precipitating or causing the swelling or inflammation to take place then, the treatment becomes much clearer.

So as it turns out the majority of what we recognize as arachnoiditis probably occurs at the level of the lumbosacral spine because that is the most frequent site of surgeries that require surgical penetration of the meninges which unfortunately in and of itself will cause swelling and inflammation ON TOP of what already may be present if nerve roots are being compressed and therefore, irritated due to pinched nerves, osteo or even rheumatoid arthritic degenerative processes. In many cases (in fact, according to Greenberg, about 50% of compressive lesions causing chronic and even disabling low back pain resulting in cases of arachnoiditis can and do SPONTANEOUSLY get better and consolidate on their own due to the person's immune system doing its own cleanup job and also due to a less than ROBUST or VIGOROUS inflammatory response by the arachnoid layer itself.

Treatments in general should be directed at the CAUSE of swelling and inflammation which can include agents such as corticosteroids like SOLUMEDROL or methylprednisolone, prednisone, and dexamethasone. Other anti-inflammatory agents include NSAIDS such as TORADOL injectable which can be very high yield where severe pain is encountered. Other less vigorous options which are believed to work to control swelling and increased pressure would be agents such as INDOMETHACIN, PENTOXYFYLLINE, ACETAZOLAMIDE, TOPIRAMATE, and MINOCYCLINE.

Other more potent and somewhat more controversial medications to use with potentially chronic and sometimes progressive conditions such as arachnoiditis would be the use of opiate drugs such as morphine formulations, methadone, percocet, anesthetic drugs such as ketamine, and then, topical analgesics such as DICLOFENAC in pill, gel, or PATCH form locally in the back/spine and there are some other analgesics. Physical means of treating arachnoiditis could involve EXERCISES for the back, TENS units for the back, and then, other methods such as ACUPUNCTURE, BIOFEEDBACK with deep breathing exercises, RELAXATION/BREATHING TECHNIQUES, or in some cases massotherapy.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

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This query has utilized a total of 32 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

A good physical or back exercise program should also be given in order to keep the skeleton moving which is believed to prevent nerve roots to clump or stick together which will only increase swelling and irritation and eventually pain and limitation of movement.

Exercises that keep the lower back and long nerve tracts limber which as straight leg raising and foot flexing forward and backward are believed to be very helpful.

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Brief Answer:
Arachnoiditis treatment options

Detailed Answer:
You are absolutely correct. Your symptoms and sensations are entirely consistent with arachnoiditis which turns out to be one of the most stubborn and difficult forms of back pain to treat when it occurs in the lower lumbar region as a result of either surgieries, epidural shots, or other traumatic or chemical injuries.

In some of my patients the feelings of creeping/crawling feelings can be reduced or ameliorated by dopaminergic drugs such as Mirapex, Requip, or Sinemet which are drugs used for RESTLESS LEGS SYNDROME. In some cases I've combined these drugs with a muscle relaxant such as tizanidine. There are less commonly used anti-neuropathic drugs that you may speak to your doctor about as well such as MEXILETINE which I use as a 3rd line drug for diabetic neuropathies but care must be taken since this can be troublesome in some heart patients as a calcium channel blocker. EKG is recommended to be used to make sure no arrhythmias are present in any patient before starting this drug. But it can be ameliorating for neuropathies that do not respond to other agents. Also, some anti-epileptics such as Tegretol, Dilantin, and Valproic Acid have been successfully used in some patients with neuropathic pains caused by different things. I suppose the typical standbys of gabapentin and/or pregabalin (Lyrica have been tried already?).

I hesitate to recommend a Vagal stimulator because I've only seen a handful of patients with back pain of ANY sort respond to this modailty...and really nobody of my population with arachnoiditis have ever said that the stimulator ever worked. The problem with a stimulator is that it has to be surgically placed and I would be very cautious about allowing any further surgical manipulation to occur in that area which remains HOT following the epidural. Along the NOT SO GREAT ideas of surgical options would be an intrathecal pump that could be programmed to release either something like BACLOFEN if your pains involve muscle spasms.....or just simply analgesic medication recommended by your pain management team but which can be tied to complications of dependency, tolerance, and withdrawal symptoms at whatever point you decide that you no longer want to use that type of pain support DIRECTLY within the central nervous system.

Some patients successfully use a TENS unit. Also, there are conservative modalities to consider for the straight pain that is designed to increase mobility and improve circuloation to the affected region (which needs to be maintained despite the pain) such as AQUATHERAPY, MASSOTHERAPY, and ULTRASOUND/DIATHERMY.

Hopefully, you can glean some different ideas from this list of options and discuss these with your doctors and come up with a better solution than what you've got now.

If so, could you do me the favor of CLOSING THE QUERY with positive words of feedback and a 5 STAR rating? I do hope you find at least a better SHORT TERM and perhaps long term solution to this problem and if you do please let me know by dropping me a line at: www.bit.ly/drdariushsaghafi

This query has utilized a total of 52 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

A good physical or back exercise program should also be given in order to keep the skeleton moving which is believed to prevent nerve roots to clump or stick together which will only increase swelling and irritation and eventually pain and limitation of movement.

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Brief Answer:
You are very welcome-- All the best for relief SOON

Detailed Answer:
Thank you for your clarifications. I'm sure you've been through a number of things over the years and I wish there were an easy fix to this type of problem but we just don't have a great handle on this problem. However, with some of the ideas that I've provided my hope is that you will find some new idea or combination of ideas that can offer relief soon.

I am on board with you in trying to avoid any and all surgical procedures. That simply adds more risk for scarring and additional things on top of what's already there....not what you want.

All the best. Please let me know how things go in the future if any these ideas help since I can use them to help others as well. Cheers!

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