Arachanoiditis; Low Back Pain; Spinal Surgery; Spinal Fusion

[title size=”1″ content_align=”left” style_type=”single” sep_color=”” class=”” id=””]Question[/title][testimonials design=”classic” backgroundcolor=”” textcolor=”” class=”” id=””][testimonial name=”” avatar=”male” image=”” image_border_radius=”” company=”” link=”” target=”_self”]I’m 49 years old. In 1992, I had low back pain, and it went down my right leg and into my foot. They did a fusion L5/S1 with plates and screws.

After one year, to the day, they took the plates and screws out, and since that time 1993, to present, I suffer chronic pain on a daily basis. I was diagnosed with something called Arachanoiditis. I’m back on more oral medication, which of course, is not good for your body but without the medication I have no life at all. Any suggestions?[/testimonial][/testimonials][separator style_type=”none” top_margin=”” bottom_margin=”20″ sep_color=”” icon=”” width=”” class=”” id=””][title size=”1″ content_align=”left” style_type=”single” sep_color=”” class=”” id=””]Answer[/title][testimonials design=”classic” backgroundcolor=”” textcolor=”” class=”” id=””][testimonial name=”” avatar=”male” image=”” image_border_radius=”” company=”” link=”” target=”_self”]Arachnoiditis is an odd diagnosis. It is the inflammation of one of the membranes that surrounds the spinal cord, the one that’s on the inside. So what’ll happen is, is these teeny tiny little attachments will go from the thicker portion of the membrane, attach into the spinal cord and when you end up something that aggravates the area and sets up an inflammatory reaction. If you’re really, really unlucky—and I suspect that you are that person—these structures become inflamed, which causes scarring down the spinal cord.

If you find somebody with arachnoiditis, the very last thing you want to do is to do anything mechanical in the spinal cord in that area. So the fact that they did an intrathecal morphine pump, is not well thought through. The catheter itself will make the arachnoiditis worse. The morphine in that area can make the arachnoiditis worse.

So what you have to do is look at the underlying problem and then work around it, then trying to sort through the symptomatic relief options that are available to you. You do not need to deliver opiates directly to the spinal cord.

Opiates do not work any differently than if you take them orally, or rectally, or transdermally for that matter. If I were treating you, the first thing I would do would be to deal with the inflammation around the spinal cord. I would do that with a series of different anti-inflammatories. Usually you have to use them in combination for optimal results. Then, the most relief that you’re going to get pain wise actually is going to be from anticonvulsants.

They’ve already tried you on Neurontin. The problem with Neurontin, is it that it has a ceiling absorption. So in other words, you can take up to 3,600 mg, and all of a sudden the amount that gets absorbed starts to drop off rather precipitously. Because they don’t seem to understand how this works, The doctor will throw more, and more, and more, and still nothing happens. Then they go, “oh gee, this medication didn’t work.” When in fact, it did. What they were supposed to have done was, stopped dosage at 300 to 600mg, and then add a second GABA-agonist. Then all of a sudden, things start to work fine.

You’re best analgesic to treat this problem is methadone, because methadone has a predictable GI absorption. It’s a fascinating medication but it’ll give you the relief that you need.

Arachnoiditis terrible, terrible problem, and this is one of the reasons why you tell people, “do not get your back operated on.” There are lots of interesting treatment options other than surgery. Surgery ought to be a last resort.[/testimonial][/testimonials]

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.