Three-Component Protocol

Adhesive Arachnoiditis does not respond to single-drug treatment. It is a complex, progressive condition involving chronic neuroinflammation, nerve and tissue damage, and intractable pain — and it requires a multi-layered approach that addresses all three problems simultaneously.

Dr. Forest Tennant, one of the only physicians to dedicate his career to researching and treating Arachnoiditis, developed what he called the Three Component Protocol. It is built on a simple but important principle: a protocol identifies and simultaneously administers multiple therapies against a disease to obtain a superior result compared to any single treatment alone.

This article is based on his most current guidance, Bulletin 8 (February 2026). His foundational document, Bulletin 15, remains a valuable reference. They are linked below as well.

As always, this information is educational. Work with a qualified physician before making any changes to your treatment.

The Three Components

Dr. Tennant identified three distinct problems in AA that must be treated together:

1. Pain — which must be controlled for the patient to function and heal

2. Neuroinflammation and autoimmunity — the underlying cause driving progression

3. Tissue and membrane damage — requiring active regeneration

Note the order. Pain comes first — not because it is the most important problem, but because a patient cannot engage with healing if they cannot function. Comfort is a prerequisite for recovery.

Component 1 — Control of Pain

The goal here is enough comfort to function and heal. Dr. Tennant recommends a combination approach:

A. A short-acting opioid plus a neuropathic agent

Opioid options: tramadol, codeine, hydrocodone, oxycodone-acetaminophen, hydromorphone

Neuropathic agent options: diazepam, clonazepam, lorazepam, alprazolam, gabapentin, baclofen, pregabalin

B. Palmitoylethanolamide (PEA) with luteolin 600 to 1200mg twice daily. PEA is a naturally occurring compound that modulates inflammation and pain at the cellular level.

C. Low Dose Naltrexone (LDN)Listed as an add-on option for mild or new cases at 0.5 to 1.0mg twice daily. For more detail on LDN see our dedicated guide.

Component 2 — Suppression of Inflammation and Autoimmunity

This is the treatment of causation — addressing the neuroinflammation that drives AA progression.

A. Diet and foundational supplementsDaily protein from seafood, beef, or poultry. Anti-inflammatory fruits and vegetables. Sugar-restricted diet. Key vitamins and minerals: C, B-12, D, magnesium, selenium, zinc.

B. Anti-inflammatory medicationsKetorolac 10 to 30mg one to three days per week, plus either methylprednisolone 4mg or dexamethasone 0.05mg one to three days per week.

C. Additional optionsDiclofenac, meloxicam, pentoxifylline, acetazolamide, thymosin, KPV peptide

D. Supplement choicesOne or more of: curcumin, resveratrol, luteolin, glutathione, serrapeptase, andrographis, ashwagandha, lysine

Component 3 — Regeneration of the Arachnoid Membrane and Cauda Equina

The goal of this component is to attempt some degree of permanent recovery by supporting the body's ability to repair damaged tissue. Dr. Tennant recommends beginning this component only after stabilization on Components 1 and 2.

A. Spinal fluid flow exercisesMovement that promotes spinal fluid circulation: swinging, rocking, trampoline, deep breathing, arm swings, walking, stretching, flexing, massage, weightlifting.

B. Regenerative supplementsDaily colostrum, deer antler velvet, DHEA or pregnenolone 100 to 200mg twice daily.

C. Peptides and hormonesAfter stabilization on Components 1 and 2, Dr. Tennant recommends selecting one of two peptide options administered alongside HCG:

• BPC-157 with thymosin, or ARA 290

• Human chorionic gonadotropin (HCG)

Add-on option: Electro-medical measures such as PEMF or scrambler therapy are an option

A Note on Protocol Evolution

Dr. Tennant refined this protocol over decades of clinical practice. Bulletin 15 established the foundational framework and remains widely referenced in the Arachnoiditis community. Bulletin 8 (February 2026) reflects his most current guidance and is the version this article is based on. We recommend downloading and sharing both with your physician.

📄 Download Bulletin 8 — February 2026📄 Download Bulletin 15

Working With Your Physician

This protocol is most effective when all three components are addressed together and adjusted over time. No two AA patients are identical. If your physician is unfamiliar with this framework, bring them a copy of Bulletin 8. Our Physician Directory lists doctors with experience treating Arachnoiditis who may be better positioned to support your care.

This article is for educational purposes only and does not constitute medical advice. Always consult a qualified physician before making changes to your treatment plan. See our Disclaimer.