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TREATMENT PLANS

NEURO-INFLAMMATION

Arachnoiditis is caused by neuro-inflammation and is most commonly found in the Lumbar region of the spine. Although the term arachnoiditis simply implies inflammation of the arachnoid lining of the meninges or thecal sac, the major cause in the vast majority of lumbar cases is neuroinflammation of the nerve roots in the cauda equina. Once glia cells in nerve roots produce neuroinflammation, they may form adhesions and scars that may cause nerve roots to stick together or clump and adhere to the arachnoid lining. When this occurs, it is called Adhesive Arachnoiditis (AA). Because of the location of the nerve roots in the lumbar area, AA may progress to cause bowel and bladder dysfunction; gastrointestinal issues; inability to sit or stand for long periods of time; autoimmune disorders and can eventually lead to paralysis, although with current treatment options, that's rare.

 

There are multiple causes of the neuro-inflammation that can lead to Arachnoiditis such as degenerative disc disease (DDD); degenerative arthritis; spinal stenosis; trauma; meningitis; infection and botched epidurals. 

Joint Pain
Tissue Regeneration.jpg

Like all inflammation, a modest amount is part of the normal healing process, but too much causes tissue destruction with adhesive and scarring.  This is why with Adhesive Arachnoiditis you need to follow the Three Component Protocol (Bulletin 15) from Dr. Tennant. We will go through the three elements of the protocol and the medications that work for each component.

Neuro-inflammation Reduction

This is the list of prescriptions and supplements that reduce neuro-inflammation

 

  • Naltrexone

  • Ketorolac

  • Methylprednisolone

  • Dexamethasone

  • Indomethacin

  • Diclofenac

  • Metformin

  • Acetazolamide

  • Pentoxifylline

  • Curcumin

  • Serrapeptase

  • Adrenal Cortex


 

Tissue Regeneration

  • Pregnenolone

  • DHEA

  • Testosterone

  • Medroxyprogesterone

  • Estradiol

  • Human Chorionic Gonadotropin (HCG)

  • Nandrolone

  • Collagen supplements

  • B12

  • Vitamin C

  • Colostrum

NEUROPATHYAND NOCICEPTIVE PAIN

Since Adhesive Arachnoiditis can involve damage to both nerves and tissue, it's both neuropathic (pain stemming from nerves) and nociceptive (damaged tissue) and each type of pain involves different methods for treating them. 

 

Neuropathic pain is caused by inflammation, irritation or neural tissue compression that needs to be treated with both the inflammatory reduction component and the pain control component of the Three Component Protocol. Gentle stretching, showers/baths, rocking chairs, and walking can also help with neuropathy.

 

Nociceptive Pain responds better to physical therapy to help strengthen and stretch the affected muscles or joints, or gentle stretching at home. Over-the-counter medicines, such as acetaminophen or ibuprofen. Prescription medicines, like opioids or antidepressants.

Drug Metabolism Testing; Pharmacogenomics

It's highly recommended that you get opioid metabolism testing (pharmcogenomics) done before starting on pain medications. This genetic testing measures how you body metabolizes certain prescription pain medications to help understand what medications work the best and how much to take. To learn more about pharmagenomics, please read this article from the National Institutes on Health (NIH)

National Institutes on Health and Pharmacogenomics:

https://www.nigms.nih.gov/education/fact-sheets/Pages/pharmacogenomics.aspx

 

Pain control agents:

  • Ketamine

  • Kratom

  • Palmitoylethanolamide (PEA)

  • CBD

  • Oxytocin

  • Gabapentin

  • Topiramate

  • Pregabalin

  • Duloxetine

  • Baclofen

  • Opioids

  • Adderall®

  • Methylphenidate

  • Carisoprodol

  • Diazepam

  • Alprazolam

  • Clonazepam

  • Amitriptyline

  • Lidocaine patch

Bulletin 78 - Treating Neuropathic Pain in AA

 

 

 

 

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Arachnoiditis Flare-ups

If you have active Arachnoiditis or Adhesive Arachnoiditis, the odds are you're going to experience what we call a flare up. The intensity can be minor, moderate, severe and can last hours to several days, or more. Without warning, Adhesive Arachnoiditis can flare up and lead to further progression. There are several steps you can take to lessen the severity of a flare up, or to build a good foundation.

 

Step #1 Determine Your Type of Deterioration. Are there new symptoms such as weakness, bladder/bowel dysfunction, balance, walking, or jerks/tremors. Is there more pain resulting in more burning, stabbing, or other neurological pain.

 

Step#2 Take a blood test to check levels for hormones, inflammatory markers, glucose, and cholesterol.

 

Hormone test should include; cortisol, DHEA, pregnenolone, testosterone

Inflammatory Markers blood test should include: ESR, CRP, cytokines

 

Note: A hormone deficiency may cause increased impairments, pain, or both. An elevated inflammatory marker calls for more aggressive control of spinal canal inflammation. Please check out these bulletins to learn more about checking for and treating hormone deficiencies. 

 

Bulletin 68 - Steps to Take if You’re Deteriorating 

 

Bulletin 57 – Blood Test for AA

BLOOD HORMONE LEVELS

It’s recommended that you consult your physician before starting any new vitamins or supplements. It is also recommended that you ask your physician about testing your blood hormone levels before starting any hormone supplements. These blood test check how well your endocrine system is working. Chronic pain can cause your system to become depleted. These tests are an important step in effectively treating the neuroinflammation from arachnoiditis.

 

The hormone test should include; cortisol, DHEA, pregnenolone, testosterone.

Inflammatory Markers blood test should include: ESR, CRP, cytokines

Other blood testing should include blood sugar and cholesterol levels.

 

Note: A hormone deficiency may cause increased impairments, pain, or both. An elevated inflammatory marker calls for more aggressive control of spinal canal inflammation.

Download and print this helpful bulletin on the necessary blood tests for AA

Bulletin 57 – Blood Test for AA

Organizing Test Tubes

Spinal Fluid Blockage

The majority of patients who have reached the adhesive Arachnoiditis stage suffer from spinal fluid issues such as leaks, seepage, and blockage/obstruction from the scar tissue. This can lead to blurry vision, ringing in your ears, brain fog/memory issues, headaches, neck and shoulder pain, nausea. 

 

The symptoms you'll experience depend on what type of cerebral spinal fluid (CSF) issue you're having. For obstruction, the buildup of CSF causes the pressure in your spine to increase, which in turn causes pressure on your brain. On the other hand, a CSF leak can cause your spinal pressure to drop, which results in a myriad of complications that are similar to high spinal pressure.

 

There are some medications and supplements you can take to help with CSF leakage and seeping. L-arginine works by increasing the blood flow to the dura which helps to rebuild and strengthen it.

CSF related files

CSF Resources

Tarlov Cysts

Tarlov cysts are formed as a result of the scarring that Adhesive Arachnoiditis causes. It can vary in severity from mild thickenings to catastrophic adhesions that ruin subarachnoid space. As a result, arachnoid cysts can be formed.

Tarlov Resources

  • Tarlov Cyst Foundation

https://www.tarlovcystfoundation.org/

  • Tarlov Cyst Society Europe

https://www.facebook.com/groups/tarlovcysteurope/?ref=share

  • Vigdis Thompson Foundation

Dr. J. Peter Warnke (Tarlov Cyst & Arachnoiditis)

https://www.vigdis-thompson-foundation.org/de/

 

The Vigdis Foundation

Germany based foundation dedicated to Arachnoiditis and Tarlov Cysts. You can request a consultation with them if you're suffering from both these conditions. They do request a donation, if you can afford it, because they're a nonprofit organization

Collagen Diseases

 

Collagen diseases such as Ehlers Danlos Syndrome (EDS), another rare disease, can sometimes be found alongside Arachnoiditis

https://arachnoiditishope.com/ehlers-danlos-syndrome/

EDS Awareness- great website for EDS information

https://www.chronicpainpartners.com/how-to-improve-your-quality-of-life-while-living-with-ehlers-danlos/

More  Resources

Want to learn more about Arachnoiditis? Read this great article in Practical Pain Management by Dr. Tennant

https://www.practicalpainmanagement.com/pain/spine/suspecting-diagnosing-arachnoiditis?page=0%2C0

 

Biomarkers in Connective disease, including Arachnoidiotis