Inflammation of the arachnoids is refers to as arachnoiditis. The underlying symptoms include chronic and persistent pain in the lower back, limbs and sometimes in the entire body.
The term arachnoiditis means "inflammation of the arachnoid" and it can involve the brain or any part of the spinal cord. Spinal arachnoiditis is more common than the cerebral/cranial variety.
The arachnoid lining is one of the 3 membranes (meninges) that surround the brain and spinal cord. The inflammation results in continuous irritation, scarring, and binding of nerve roots and blood vessels. Symptoms of arachnoiditis can vary from a skin rash to moderate or severe pain, to paralysis. The characteristic feature of arachnoiditis is severe stinging and burning pain and neurologic problems.
The causes of arachnoiditis can be categorized in the following four groups:
- Trauma: The meninges can be endure trauma as a result of spinal surgery (often multiple procedures), cranial or spinal injury, or needle insertion to remove CSF for testing
- Injections: Injection of anesthestic drugs, corticosteroids, medications, or medical dyes/chemicals injected near the spinal cord (epidural) or directly into the cerebrospinal fluid (CSF)
- Infection: Infection of the arachnoid/CSF (meningitis)
- Blood: Blood in the cerebrospinal fluid (CSF) secondary to trauma, spontaneous bleeding, or infection
Pain: The major symptom of arachnoiditis is chronic and persistent pain in the lower back, lower limbs that in severe cases can involve the entire body.
Other symptoms of arachnoiditis are:
Tingling, numbness, or weakness of the lower limb (legs)
Peculiar feeling like insects crawling on the skin or water trickling down the leg
Severe shooting pain like an electric shock sensation
Muscle cramps, spasms, and uncontrollable twitching
Dysfunction of bladder, bowel and/or sexual dysfunction
In patients with progressive disease the symptoms can become more severe or even permanent. Arachnoiditis can be very debilitating if the pain is constant and intractable.
Radiological imaging: Computed tomography (CT) scan or magnetic resonance imaging (MRI) scan are the most reliable method of ascertaining the diagnosis of arachnoiditis. The imaging studies may be negative or equivocal in early stages of inflammation. MRI can help to define the location and the extent of disease.
Spinal fluid analysis: Analysis of CSF for certain cell types and proteins can be help to establish the diagnosis in the early stages of inflammation.
In some patients’ even clinical analysis, radiological imaging and spinal fluid analysis may not confirm the diagnosis.
Treatment for arachnoiditis is similar to treatments for other chronic pain conditions and aims for pain relief only.
NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac. mefenamic acid can be used to relieve pain
Narcotic pain relievers: Narcotic analgesics such as codeine or morphine may be used for severe pain relief. These medication do not always work well and if used for a longer period of time they can cause several side effects or even dependence
Corticosteroids (orally or injected): These are indicated if conservative medical treatment fails to ease pain. Epidural steroid injection may be given adjacent to the inflamed meninges to relieve pain.
Muscle Relaxants: Muscle relaxing medications (such as carisoprodol, chlorzoxazone, methocarbamol, diazepam) may ease muscle spasm and relieve pain in some patients.
Anti-convulsants such as carbamazepine, gabapentin, lamotrigine or phenytoin, can help with burning pain.
Transcutaneous Electrical Nerve Stimulation (TENS): Electrical current given specific nerves through electrode patches that are placed on the skin can relieve pain in some patients. The electrical current produces heat that relieves stiffness, improves mobility, and lessens pain.
Surgery: Surgery is not recommended for arachnoiditis as it increases formation of scar tissue and exposes the irritated spinal cord to additional trauma.
Physical therapy like hydrotherapy, massage, and hot/cold therapy has been noted to benefit some patients. Other alternative therapies that may be effective in the management of pain in arachnoiditis include yoga, osteopathic medicine, physiotherapy, relaxation, hypnosis, biofeedback and nutritional supplementation. Several patient support groups have reported effectiveness of alternative therapies in arachnoiditis.
Psychotherapy can help to deal with the chronic pain. You should stay positive and have a support structure or group which can help you to adjust to the physical and mental changes in your life brought about by arachnoiditis.
Home care is rarely effective in relieving pain of arachnoiditis. As the pain in arachnoidits is severe and can affect a patient’s quality of life, your doctor may recommend that you join a support group to find help in handling the mental stress of living with condition.
Some measures which may prevent arachnoiditis are:
- Avoid unnecessary injections in the spinal cord (such as anesthetics, radio-contrast dyes)
- Do surgical procedures delicately and according to guidelines to avoid unnecessary trauma to the spinal cord.
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