The 6-Day Medrol Dose Pak and Low Dose Corticosteroids for Adhesive Arachnoiditis

If your pain is out of control, you are making frequent emergency visits, your function has deteriorated significantly, and nothing seems to be working — you may be experiencing uncontrolled neuroinflammation.

This is one of the most common patterns Dr. Forest Tennant encountered in his decades of treating Adhesive Arachnoiditis. And one of the most effective responses he found was straightforward: a 6-Day Medrol Dose Pak followed by ongoing low dose corticosteroid therapy.

This article is based on Bulletin 22 (June 2026) from the Tennant Foundation, available to download below.

Why Instability Happens

Clinical instability in AA is almost always inflammation that is out of control. That inflammation may be occurring in the cauda equina and arachnoid membrane — the primary sites of AA — but also in the glial cells of the brain and spinal cord.

When inflammation spreads to both areas simultaneously, symptoms escalate rapidly. Pain becomes unmanageable, function deteriorates, and the standard day-to-day treatment protocol stops being enough.

The inflammation needs to be immediately controlled in both anatomic areas and then suppressed on an ongoing basis. This is where corticosteroids come in.

Why Corticosteroids

No class of drugs or medicinals has shown the ability to suppress and control inflammation like corticosteroids. For AA patients in an unstable period, they are the most powerful tool available for rapidly bringing neuroinflammation under control.

This does not mean they are without considerations — long-term high-dose corticosteroid use carries risks. But at low, intermittent doses, research has shown they can be used safely over extended periods. More on that below.

Step 1 — The 6-Day Medrol Dose Pak

The Medrol Dose Pak is a tapering course of methylprednisolone taken over six days. It delivers a rapid, significant suppression of inflammation throughout the body including the spinal canal and brain.

It works on a temporary basis — it is not a permanent solution on its own. But it serves two important purposes:

First, it provides immediate relief during an unstable period. Second, it acts as a diagnostic tool. If a patient improves significantly on the Medrol Dose Pak, that improvement confirms that uncontrolled inflammation is the primary driver of their instability. That diagnosis then guides the next step.

Step 2 — Ongoing Low Dose Corticosteroid Therapy

If the Medrol Dose Pak produces improvement, ongoing low dose corticosteroid therapy should be started to maintain that suppression.

Dr. Tennant's recommendations for ongoing low dose therapy:

• Prednisone 2.5 to 5.0mg on 2 to 3 days per week

• Methylprednisolone 2 to 4mg on 2 to 3 days per week

• Dexamethasone 0.5mg on 2 to 3 days per week

Research supports that prednisone at 2.5 to 5.0mg taken on 2 to 3 days per week can be maintained for an extended period without significant complications. The intermittent dosing — rather than daily — is key to minimizing side effects while maintaining anti-inflammatory benefit.

Dr. Tennant's clinical observation is direct: few cases of AA do really well without low dose corticosteroids.

Who Should Consider This

This approach is most relevant for AA patients who are:

• Experiencing a period of significant instability

• Not responding adequately to their current treatment protocol

• Making frequent emergency or urgent care visits for pain

• Experiencing rapid functional decline

It is also relevant as part of the Emergency Protocol for newly suspected AA. The Medrol Dose Pak appears in both contexts because it is one of the fastest ways to suppress acute neuroinflammation regardless of whether AA is newly developing or long established.

Working With Your Physician

Bring Bulletin 22 to your physician appointment. Many physicians are unfamiliar with low dose intermittent corticosteroid therapy for AA specifically, but the research supporting low dose long-term corticosteroid use in inflammatory conditions is well established and can support that conversation.

If you are struggling to find a physician who understands AA, our Physician Directory lists doctors with experience treating this condition.

📄 Download Bulletin 22 — June 2026

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.