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ARACHNOIDITIS
Ross Hauser, M.D.
Arachnoiditis is
typically diagnosed in someone who has undergone
back surgery and still suffers
severe back pain that radiates down the legs and often to the feet. The pain has
a persistent burning, stinging, or aching quality. The diagnosis is occasionally
made when similar symptoms are felt in the neck, arms, or the mid back with
radiation into the chest. This pain is typically unresponsive to
pain medications and muscle relaxants.
The term arachnoiditis signifies an
inflammation of the arachnoid membrane which covers the spinal cord. The
diagnosis of arachnoiditis is generally inaccurate because no signs of
inflammation such as redness,fever, or an elevated sed rate (blood test that
identifies inflammation) are seen in these patients. All that is seen is scar
tissue on the
MRI.
Arachnoiditis is another condition
that is typically diagnosed by the large metal box with a magnet in it. For the
patient who succumbed to surgery, only to be left with continued or worsened leg
pains, repeated MRI and CAT scans are done. Eventually one of these scans will
show some scar tissue. The physician will then inform the patient that the
mysterious cause of the pain has been found, "You have arachnoiditis. Scar
tissue is pinching the nerves."
It is common for someone with
severe burning pains in the legs to receive a diagnostic study such as an MRI or
CAT scan of the lower back. These tests are performed because they are supposed
to reveal the source of the problem to the physician. The problem with this
logic is that the MRI or CAT scan is designed to reveal density and
configuration of structures, not diagnose conditions. Physicians are supposed to
diagnose but unfortunately for many people with
chronic pain, physicians have
left the diagnosing to a large metal box with a magnet
in it.
The patient in the above scenario
is at first ecstatic because "the cause" of the pain has been found.
The patient's jubilation is short-lived when the
physician tells the patient that arachnoiditis is not curable, but the pain can
be "controlled." Imagine having surgery for back and leg pain
and
coming out of the surgery with the same back and leg pain. The doctor then says
the pain is due to scar tissue pinching on the nerves. How did the scar tissue
get there? The answer is from the surgery, of course.
The problem with this diagnosis is
that the scar tissue was not present before the surgery, but the back and leg
pains were. So what explains the back and leg pain
that occurred before surgery? Answer that one and you will have the answer to
why the person suffers from back and leg pain after surgery.
A more logical conclusion is that
the surgery did not address the cause of the back and leg pain. Furthermore, the
scar tissue seen on X-ray most likely has nothing to
do with the current pain complaints of the patient. The number one cause of
low back pain
radiating into the legs is
sacroiliac
ligament laxity. Shooting pain
down the leg is commonly due to
ligament weakness in the lower back, including
the sacroiliac,
iliolumbar,
sacrospinous, sacrotuberous, and hip joint
ligaments.
The person in the above scenario needed a
Prolotherapist to
relieve the pain, not a surgeon. Anyone carrying the diagnosis of arachnoiditis
needs the immediate attention of a Prolotherapist
before succumbing to
epidural
steroid injections, more surgeries,
spinal cord
stimulator implantation, or other invasive treatments which are only marginally
helpful.
WHAT
WOULD I DO IF I HAD ARACHNOIDITIS?
Ross Hauser, M.D.
I believe (as many Prolotherapists do) that the diagnosis of arachnoiditis is
too often made when someone has chronic back and leg pain continued after
surgery and no other cause can be found.
As Prolotherapists, many of us believe that injury to the pelvic ligaments, and
not a "catch all" diagnostic label such as arachnoiditis, will give
the person chronic back and leg pain that often doesn't respond to
steroids,
pain pills, anti-inflammatories,
epidurals, and
exercise.
In our book
Prolo Your Pain Away, I wrote that many of these patients can be
helped immensely with
Prolotherapy because the problem is often due to a
sacroiliac
ligament laxity (weakness/injury) problem.
For the person with the diagnosis of Arachnoiditis, it is my recommendation that
they get an evaluation for Prolotherapy. There is very little to lose and a lot
to gain.
"Dr. Hauser, how can you say such things? Are you saying that
Mayo Clinic
and all the doctors that have been treating me for 'arachnoiditis' have been
wrong?"
For some of you, definitely yes! But not all of you. The Mayo Clinic and most
chronic pain specialists do not use Prolotherapy in their practices and are not
familiar with
ligament
injury causing chronic pain.
In 1996,
Gustav
Hemwall, M.D., the world's most experienced Prolotherapist
decided to retire after thirty-one years of giving Prolotherapy treatments. I
was extremely fortunate to be able to train with and apprentice under Dr.
Hemwell as he performed Prolotherapy. It was Dr. Hemwall who was helping many of
these "arachnoiditis" patients before there was even a term "arachnoiditis"
to describe their pain.
It was Dr. Hemwall who taught me that many of the people diagnosed with
arachnoiditis do not have reactive scar tissue that is inflamed---but have
weakness in their pelvic (sacroiliac) ligament ligaments. For these patients,
Prolotherapy could eliminate the pain.
Arachnoiditis Can Be Devastating
I know that arachnoiditis can be devastating. There are many folks that have had
a systemic reaction to contrast dye and other chemicals that have been injected
into and around their spines. This causes a massive inflammatory reaction that
can be systemic.
Shortly after my residency training in Physical Medicine and Rehabilitation was
completed, I started seeing people in chronic pain that I felt was from a
chemical sensitivity of some sort. The various suspected items included silicone
implants, medicines, drugs, injected dyes, and food substances (consumed items).
To help such patients, it became more and more clear to me over the years that
other treatment modalities were needed in addition to Prolotherapy. For the
person with systemic inflammation that was believed to be due to a chemical
sensitivity or abnormal immune reaction to such substances as contrast dye, the
following testing should be performed:
Contrast Sensitivity as depicted in the book
Desperation Medicine
Antibody levels for the substances suspected
Platelet Aggregation Studies
ISPAC to look for coagulopathy
Interferon levels
Tumor Necrosis Factor (TNF)
Interleukin levels
Other blood tests for systemic inflammation
For the person who has chemically-mediated systemic inflammation causing injury
to nerves and
connective tissue, often the inflammatory-mediator blood levels
would be elevated. This could include Interferons, Interleuken, and TNF.
Generally, a coagulopathy is also present.
"What if systemic inflammation is found?"
If a person has evidence in the blood of systemic inflammation
(inflammatory-mediators are high), then natural anti-inflammatories are given,
such as enzymes, bromelain, curcumin, ginger, and fatty acids.
One must also realize that generally, systemic inflammation is associated with
adrenal insufficiency. So if the person is found to have low adrenal gland
hormone levels then these
hormones would be supplemented. The most common
adrenal gland hormones supplemented are
cortisol
and
DHEA.
What Would I Do If I Had Systemic Arachnoiditis?
If I had systemic inflammation because my immune system reacted to contrast dye
or some other chemical and I had evidence of systemic inflammation I would treat
it first with nutriceuticals and adrenal gland hormones. My program would most
likely involve cortisol, DHEA, and Omega 3 fatty acids. I would not take
anti-inflammatory medications. If I needed a
prescription medication, I would
take Enbrel. I would give myself shots twice a week. If I was still having a lot
of problems I would have Insulin Potentiation Therapy weekly for six treatments.
If I was found to have a coagulopathy, I would start natural
blood thinners such
as garlic and high dose vitamin E. I would also use low dose coumadin or low
dose subcutaneous heparin. I would try and keep my PT or INR slightly above
normal if coumadin was given or my PTT slightly above normal if heparin was
used.
To help detox my body I would do whole body hyperthermia daily, preferably with
an infrared unit. I would try and do one hour daily. I would try and get my
temperature to at least 102 Fahrenheit.
To help decrease the pain and inflammation, I would have intravenous DMSO drips
two times per week. This is a very good substance to decrease the pain of
systemic arachnoiditis. But it has to be given intravenously. To also help
decrease pain I would have intravenous procaine in the DMSO drip. I would also
receive some type of injection treatment into the main areas of pain. If the
pain was coming from the subcutaneous tissues I would receive
Mesotherapy, if
from the nerves then
Neural Therapy, or from the muscles,
tendons or ligaments
then Prolotherapy would be done. If it was from a combination of the above, then
two or three of the treatments can be done intermittently as needed.
Having treated a lot of patients in chronic pain, many of whom came in with the
diagnosis of arachnoiditis, I have concerned myself primarily with correcting
the underlying physiology that caused the condition. If the underlying
physiological problem is systemic inflammation, then one of the above approaches
is instituted. If the pain is coming from a local structure, such as a pelvic
ligament injury, then this area is stimulated to repair with Prolotherapy. In my
experience, this approach has been very effective for my patients with localized
"arachnoiditis" a s well as for those with the systemic variety. |
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