Arachnoiditis
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?
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 tissues, 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.
If the condition continues to be disabling, then the person is given other treatment options. These might include Thalidomide and Enbrel, both of which help block or decrease TNF. Another innovative treatment for such a condition is Insulin Potentiation Therapy (IPT). In this treatment, Insulin is used to push nutrients and pharmaceutical compounds into the cell to reverse the physiology causing the condition. For conditions that involve systemic inflammation, substances such as cyclophosphamide and methotrexate are used, but in very low doses. The treatment is given one to three times per week for a total of six treatments. The condition is accessed after completion of the six treatments. If the person feels great, the treatment is stopped and the person is reevaluated in a couple of months. Sometimes only the first six treatments are needed.
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.
CARING MEDICAL SPORTS CENTER
WHAT ABOUT BACK SURGERY
FOR SPORTS INJURIES?
Nearly 95 percent of all the low back pain occurs in a six by four inch area. This is the place where the fifth lumbar vertebra connects with the base of the sacrum and they both connect to the pelvis by various ligaments.
Specifically, the lumbar vertebrae connect to the sacrum by the lumbosacral ligaments, the sacrum to the iliac crests by the sacroiliac ligaments, and the lumbar vertebrae to the iliac crests by the iliolumbar ligaments. This is the most common area in the back treated by Prolotherapy.
Athletes often come in to our clinic with detailed stories about how an orthopedist performed a discogram and CT scan, MRI, and various other x-rays, and is confident that the athletes have disc problems. It is sad to say, but many patients who have been to orthopedic or neurosurgeons tell us that the doctor never even touched them when making the diagnosis that the pain was caused by a herniated disc or pinched nerve.
Many patients who have all kinds of disc abnormalities that show up on MRI and CT scan, say they didn't even know because they had no symptoms! Scott Boden, M.D., found that nearly 100 percent of people he tested, over age 60, with no symptoms had abnormal findings in their lumbar spines on MRI scans. Maureen Jensen, M.D. and associates published in The New England Journal of Medicine the fact that only 36 percent of people with no back pain had normal MRI scans of the back. The conclusion to the study stated, "Because bulges and protrusions on MRI scans in people with low back pain or even radiculopathy may be coincidental, a patient's clinical situation must be carefully evaluated in conjunction with the results of MRI studies." In other words, DO NOT cut on a person based on MRI studies. Likewise, CT scans find a lot of abnormalities on people who have no back pain symptoms.
The Long Term Risks of Surgery
The back is a weight-bearing structure. It means that when any tissue is removed, whether it is bone or disc tissue, the likelihood of further long-term pain and arthritis is increased. The patient will often undergo a stabilization procedure with rods or bony fusion, including the areas above or below a previously operated on vertebral segment, because the area has become lax and degenerated.
Prolotherapy cures the back pain because it addresses the root cause of back pain--ligament laxity.
Even some athletes are starting to catch on that Prolotherapy can be used as a preventative measure against injury, especially during the off season. By an athlete strengthening their ligaments with Prolotherapy, at least theoretically, they should have fewer injuries during the season. The added strength to the joints should also improve athletic performance.
If an athlete or patient has spondylolisthesis (slippage of one vertebra on top of another), Prolotherapy is still indicated. In 1964, Dr. John Merriman used his over 40 years of experience as an industrial surgeon and compared surgical fusion of vertebral segments to Prolotherapy. Dr. Merriman summarized that conservative physiologic treatment by Prolotherapy after a confirmed diagnosis of ligamentous and tendinous relaxation was successful in 80 to 90 percent of more than 15,000 patients treated. This prevented quite a few unnecessary surgeries.
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