First Successful Treatment of Arachnoditis Published
/By Dr. Forest Tennant
For the first time since arachnoiditis was identified and defined in medical dictionaries in 1873, patients and physicians now have a successful peer-reviewed treatment for chronic adhesive arachnoiditis (AA).
I and my associates, Dr. Martin J. Porcelli, and Jennifer Sands, RN, have just published the results of a small study, “Low Dose Methylprednisolone and Ketorolac Treatment for Adhesive Arachnoiditis” in the International Journal of Emergency Medicine & Pain Management.
AA is a progressive inflammatory spinal disease in which cauda equina nerve roots become bound by adhesions to the arachnoid membrane, often resulting in severe intractable pain, neurologic impairment, loss of mobility, bowel and bladder dysfunction, and profound functional decline.
In our study, 20 patients with AA achieved symptomatic pain relief with low, intermittent dosages of the corticosteroid methylpredisolone and ketorolac, a non-steroidal anti-inflammatory drug (NSAID). The key goal in using these two drugs is to suppress inflammation.
Low doses of methylpredisolone 4mg and oral ketorolac 10mg (or injectable ketorolac 15-30mg) were given to patients 1 to 3 days a week. Participants took the combination for 30 to 180 days.
Seventeen of the 20 patients reported improved pain control, 13 reported improved physical activity, and 9 reported fewer bedbound days. Most patients also reported fewer pain flares and a decreased intensity of their flares.
It is fitting that the first published treatment for AA is ketorolac and methylprednisolone. These two drugs have been the most reliable and consistent medicinals for AA.
The absence of a published treatment for AA for 153 years has left patients in a dangerous vacuum. Into that vacuum came dismissal, therapeutic nihilism, medical abandonment, and the repeated phrase so many patients have heard: "There is nothing that can be done." This publication changes that conversation.
This does not mean the search for AA treatment is complete. It means the era of saying that nothing has ever been published must end, and a new treatment-development era has begun.
Going forward, we believe the new treatment can be combined with neurosteroids, biologic pain relievers, neurohormones, and peptides for even better results. Let’s hope that this first study is just the beginning.
Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. Readers interested in learning more about his research should visit the Tennant Foundation’s website, Arachnoiditis Hope. You can subscribe to its bulletins here.
The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.
