August 24, 2014: Traci Patterson – Owner, Advanced Pathways Hypnosis
What is Arachnoiditis, History, Symptoms, Causes and Treatment Options
What is Arachnoiditis
Arachnoiditis is inflammation of the arachnoid, one of the membranes known as meninges that surround and protect the nerves of the central nervous system, including the brain and spinal cord which contains the cerebrospinal fluid. The arachnoid can become inflamed because of adverse reactions to chemicals, infection from bacteria or viruses, as the result of direct injury to the spine, chronic compression of spinal nerves, complications from spinal surgery or other invasive spinal procedures, or the accidental intrathecal injection of steroids intended for the epidural space. Inflammation can sometimes lead to the formation of scar tissue and adhesion that can make the spinal nerves “stick” together. This can be extremely painful, especially in last stage adhesive arachnoiditis.
The National Organization for Rare Disorders (NORD) divides arachnoiditis in the following way:
- Adhesive Arachnoiditis
- Arachnoiditis Ossificans
- Neoplastic Arachnoiditis
- Optochiacmatic Arachnoiditis
- Postmyelographic Arachnoiditis
- Rhinosinusogenic Cerebral Arachnoiditis
- Spinal Ossifying Arachnoiditis
- Cerebral Arachnoiditis
There have been medical findings of typical lesions of spinal tuberculosis linked to arachnoiditis, in the spines of some Egyptian mummies dating back to over 5,000 years ago. In the last two decades there has been an increase in the number a patients being referred for various treatments such as myelograms, ganglion blocks, sympathetic blocks, epidurals, other injections into the spine to help with pain or even laminectomies. But, for some people these procedures can lead to a debilitating diagnosis of arachnoiditis.
Arachnoid inflammation can lead to many painful and debilitating symptoms. Chronic pain is common, including neuralgia. Numbness and tingling of the extremities is frequent in patients due to spinal cord involvement. Bowel, bladder, and sexual functioning can be affected if the lower part of the spinal cord is affected. While arachnoiditis has no consistent pattern of symptoms, it frequently affects the nerves that supply the legs and lower back. Many sufferers find themselves unable to sit for long (or even short) periods of time, often due to severe pain as well as efferent neurological symptoms, such as difficulties controlling limbs. This is particularly problematic for patients who have trouble standing or walking for long periods, as wheelchairs don’t help them. Some sufferers benefit from relatively new inventions, such as the Segway or less expensive alternatives. Standing wheelchairs are also available, although often expensive and limited compared to these alternatives. However, standing endurance and vibration tolerance should be considered before selecting a motorized assistance device.
It is critical that patients realize that arachnoiditis symptoms vary greatly, and not all sufferers experience all symptoms. Consequently—while typically significantly life-altering—the outcome, especially with physical therapy, appropriate psychotherapy, and medication, may be better than many patients fear when they first hear the diagnosis.
The usual causes of spinal arachnoiditis are:
- Infections like tuberculosis, AIDS, fungus and meningococcus can lead to arachnoiditis, but this is NOT always the case.
- Dyes used for myelograms like pantopaque, metrizamide, omnipaque, etc.
- Blood entering the spinal sac, (i.e. from subarachnoid hemorrhage, epidural blood patches, bleeding from anticoagulants, etc.)
- Spinal surgery, (the most common cause today) is mostly from a tear in the dura which allows blood to enter the cerebrospinal fluid. The other direct cause if from a spinal cord or nerve root injury during surgery.
- Irritant compounds injected into the sac such as hypertonic saline, phenol, methotrexate, hyaluronidase, papain, etc.
- Preservatives contained in some medications injected into the spine such as polyethylene glycol, benzylic alcohol, para-aminobenzoic acid, etc.
- Traumatic injury to the spinal cord or the brain may result in bleeding into the cerebrospinal fluid, nerve tissue damage or avulsion. Even needle punctures causing paresthesia on the nerve roots or the spinal cord (from epidural, spinal anesthesia or other nerve blocks) may cause arachnoiditis.
Unfortunately, there is no cure for arachnoiditis.
Arachnoiditis is difficult to treat. Treatment is limited to alleviation of pain and other symptoms. In the acute inflammatory phase, the administration of systemic and intraspinal corticosteroids may prevent the evolution into the chronic phase.
Once the proliferative phase starts, any intervention may exacerbate that pain path mechanism. Therefore, invasive procedures have to be selected if the risk/benefit ratio is favorable. Surgical intervention generally has a poor outcome, and only provides temporary relief. Steriod injections, administered either intrathecally or epidurally have been linked as a cause of the disease, therefore they are generally discouraged as a treatment and may even worsen the condition.
Doctors have different views about this disease so seeking a second opinion may be wise. A variety of new therapeutic agents and interventional modalities are being proposed mostly for the symptomatic treatment of arachnoiditis. At this juncture it is critical to decrease pain levels and decrease the inflammation to increase the flow of cerebrospinal fluid. This can be done via ketamine infusions and other medications to decrease inflammation. The use of ketamine in an infusion does require the patient to undergo ‘boosts’ to keep their pain and inflammation under control. Another ‘drug-free’ way to treat arachnoiditis is with hypnosis. Yes, hypnosis is a very effective way to control pain, reduce inflammation, control stress/anxiety, improve sleep and other side effects of arachnoiditis. (It is essential to see someone that holds a certification in pain management, in addition to a certified/credentialed in hypnosis.)
However, the most important therapy is prevention, since most of these cases are iatrogenically caused. Education of physicians, nurses, and technicians regarding the numerous causes of this disease is an essential initial step, followed by the information to the public in general, and to patients with spinal disease in particular, so as to warn them against accepting questionably effective procedures in desperation to have their pain relieved and to procure competent and responsible physicians in their care. Once an injurious event takes place, prompt action to define the precise diagnosis and to institute a treatment plan is urgent. There is no place for hesitation since there is only a short window of opportunity during which chances to reverse the process are feasible. Once the proliferative phase begins, there is only symptomatic treatment.
If you would like more information on ‘Drug-free’ treatment options for Arachnoiditis please contact, Traci, at Advanced Pathways Hypnosis.
- PDR US-FDA 2010 DataSheet | Depo-Medrol | Pfizer
- DA Nelson, WM Landau | Intraspinal Steroids: History, Efficacy, Accidentality, and Controversy with review of United States Food & Drug Administration Reports | Neurosurgery/Psychiatry Review | 2001