Pain Management Treatments for Arachnoiditis

the word "arachnoiditis" on a diagnosis sheetQuestion: I just finished reading the answer concerning rhizotomy and am left with another question. If this procedure "cooks" the nerves to gain pain relief, would it be a viable option for patients with arachnoiditis? And if not, is there a treatment for this horrific condition?
—Nashville, TN

Answer: Thanks for your question about arachnoiditis, which is a very painful condition that affects your spinal nerve roots. In my previous answer on radiofrequency rhizotomy, I did say that it "cooks" the nerves. However, RF is used to treat joint pain, and arachnoiditis is a problem inside the spinal canal. That area and the nerves in the spinal canal can't be treated by RF, unfortunately.

Here's why radiofrequency rhizotomy won't work for arachnoiditis:
Arachnoiditis is an inflammation of one of the protective layers around the spinal canal. You can think of it as scar tissue that develops in the arachnoid lining. The lining can become inflamed due to repeated intervention on the spine: many surgeries can lead to scarring, for example. It can also develop because of certain spinal infections and perhaps because of chemicals in epidural steroid injections, especially if those chemicals get into the spinal fluid.

Arachnoiditis causes the nerve roots to clump together; this clumping can cause nerve pain, numbness, and tingling. Patients with arachnoiditis tend to have pain no matter what position they're in or what they're doing. Moving around or avoiding some movements won't bring pain relief because the pain is from the arachnoid lining inflammation, not from a joint.

Radiofrequency rhizotomy is most effective on joint pain. Patients who are good candidates for RF have pain when they're doing activities that stress the spine. RF blocks the nerves around the joint from sending pain signals to the brain, and that pain-free period usually lasts around one year. In that time, patients should learn postural correction and good body mechanics. RF gives patients the opportunity to get back their mobility and learn how to go about their daily lives with less pain.

Here's what may help with arachnoiditis:
Patients with arachnoiditis do have some pain management treatment options available, although there is no cure for this condition. Patients may try medications to find pain relief. Some options are:

  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • corticosteroids
  • anti-spasm drugs
  • anti-convulsant drugs
  • narcotic pain relievers

Some of these medications may be given with a spinal pump. That's a small device implanted under the skin that delivers medication directly to the inflamed area.

Patients may also try spinal cord stimulation. My colleague, Dr. Kowlowitz, has an excellent article that explains SCS here on SpineUniverse.

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