The Basic Protocol for Treating Adhesive Arachnoiditis
/By Dr. Forest Tennant
When Arachnoiditis Hope was formed eight years ago, we had enough experience under our belt to know that treatment of adhesive arachnoiditis (AA) required 3 medical components:
Suppression of inflammation
Regeneration of the cauda equina and arachnoid membrane
Relief of pain
Our recommended basic protocol has evolved over the past eight years, based on our review of about 2,000 AA cases. This treatment protocol has been consistently successful in treating most AA cases.
The basic protocol represents our best approach to stop deterioration. Once established, we recommend additional measures in an attempt to permanently reduce pain and neurologic impairments.
The starting treatment protocol:
Relief of Pain
Choose a short-acting opioid for pain flares and exacerbations.
Options include less potent opioids, such as tramadol, codeine, buprenorphine, and hydrocodone or oxycodone with acetaminophen
More potent opioids include oxycodone (plain), morphine, fentanyl and hydromorphone
Suppression of Inflammation and Autoimmunity
Methylprednisolone 4 mg or dexamethasone 0.5 or 0.75 mg two or three days a week
Ketorolac 10 mg with meals 2 days a week or a 15 to 60 mg injection one day a week
There are alternatives to corticosteroids and ketorolac, but they do not appear as consistent or effective.
Regeneration of Cauda Equina and Arachnoid Membrane
Dehydroepiandrosterone (DHEA) 200 mg in AM and PM
Additional Measures
Supportive Diet, Vitamins and Minerals: The basic protocol is supported by a daily protein, low carbohydrate, sugar-restrictive, anti-inflammatory diet (daily fruits and vegetables), plus vitamins C, B-12, D and the minerals, magnesium and selenium.
Spinal Fluid Flow Exercises: Rocking in a chair or gentle bouncing on an indoor trampoline are recommended.
Advanced Treatment: After a person is stabilized on the basic protocol, some additional measures that are designed to permanently reduce pain and symptoms can be added. These include peptide/hormone administration, Epstein-Barr virus eradication, adhesion dissolution, electromagnetic therapy, and central pain therapy.
As we approach the end of 2025 we hope you have received some benefit from our efforts to help those suffering with adhesive arachnoiditis and related conditions. We will likely start a new bulletin series in 2026. You may wish to print or download and save some of our bulletins from 2025.
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 research bulletins here.
The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.
