Arachnoiditis

A predominant symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs or, in severe cases, throughout the entire body.

Arachnoiditis is a debilitating condition characterized by severe stinging and burning pain and neurologic problems. It is caused by an inflammation of the arachnoid lining—one of the 3 linings that surround the brain and spinal cord. This inflammation causes constant irritation, scarring, and binding of nerve roots and blood vessels.

Illustrated below—in the intradural space—are the 3 meninges (protective membranes) that surround the brain and spinal cord.

  • Dura mater
  • Arachnoid
  • Pia Mater

meninges of the spinal cord and canal, extradural and intradural spacesIn the intradural space are the 3 meninges (protective membranes) that surround the brain and spinal cord.

What symptoms can arachnoiditis cause?

The predominant symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs or, in severe cases, throughout the entire body. Other symptoms may include:

  • Tingling, numbness, or weakness in the legs
  • Bizarre sensations such as insects crawling on the skin or water trickling down the leg
  • Severe shooting pain (which some liken to an electric shock sensation)
  • Muscle cramps, spasms, and uncontrollable twitching
  • Bladder, bowel, and/or sexual dysfunction

If the disease progresses, symptoms may become more severe or even permanent. This disorder can be very debilitating, as the pain is constant and intractable. Most people with arachnoiditis are unable to work and have significant disability.
Arachnoiditis in the low back. Arachnoiditis in the low back. By BruceBlaus. Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=31339212

What are the potential causes of arachnoiditis?

There are 3 main causes of arachnoiditis:

Trauma/surgery-induced
Arachnoiditis has long been recognized as a rare complication of spinal surgery (particularly after multiple or complex surgeries) or trauma to the spine. Other similar causes include multiple lumbar punctures (especially if there is a "bloody tap" with bleeding into the spinal fluid), advanced spinal stenosis, or chronic degenerative disc disease.

Chemically-induced
In recent years, myelograms have come under scrutiny as being a possible cause of this condition. A myelogram is a diagnostic test in which a radiographic contrast media (dye) is injected into the area surrounding the spinal cord and nerves. This dye is then visible on x-rays, CT, or MRI scans and used by physicians to diagnose spinal conditions.

There is now a concern that exposure (especially repeated exposure) to some of the dyes used in myelograms may cause arachnoiditis. Similarly, there is concern that the preservatives found in epidural steroid injections may cause arachnoiditis, especially if the medication accidentally enters the cerebral spinal fluid.

Infection-induced
Arachnoiditis can also be caused by certain infections that affect the spine such as viral and fungal meningitis or tuberculosis.

How is arachnoiditis treated?

There is no cure for arachnoiditis. Treatment options are geared toward pain relief and are similar to treatments for other chronic pain conditions. Some examples include the following:

  • Spinal cord stimulation using spinal cord stimulation (SCS) is one of the best treatment options. SCS is a device that transmits an electrical signal to the spinal cord for pain relief.
  • Lidocaine intravenous (IV) infusions. One of lidocaine’s properties is that it’s a potent anti-inflammatory.1
  • Ketamine IV infusions. Ketamine, a type of anesthetic, also helps relieve pain.2
  • Low-dose naltrexone is used as an anti-inflammatory in the management of chronic pain.3
  • Pain medications such as NSAIDs, corticosteroids (orally or injected), anti-spasm drugs, anti-convulsants (to help with the burning pain), and in some cases, narcotic pain relievers. Some of these medications may be administered through an intrathecal pump which, when implanted under the skin, administers medication directly to the spinal cord.
  • Physical therapy under a doctor's direction such as hydrotherapy, massage, and hot/cold therapy.

Surgery is not recommended for arachnoiditis because it only causes more scar tissue to develop and exposes the already irritated spinal cord to more trauma.

Living with Arachnoiditis
Unfortunately, this condition can cause serious disability. It is never easy to live with chronic pain. Not only does it adversely affect your body, it can also cause mental stress as well. Sufferers of arachnoiditis are encouraged to join support groups or find other therapeutic outlets for stress. Treatment methods should be focused on pain relief and maintaining quality of life. More research is needed about this and other chronic pain conditions so that someday a cure may be found.

Updated on: 06/19/18
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