A Non-Corticosteroid Treatment for Arachnoiditis

By Dr. Forest Tennant

Methylprednisolone and other corticosteroids have been the mainstay of adhesive arachnoiditis (AA) treatment for many years.  AA is a progressive inflammatory spinal disease that causes severe intractable pain, neurologic impairment, and profound functional decline.

Understandably, there has been great resistance by AA patients and physicians to use corticosteroids due to their notorious complications. Corticosteroids are known to cause osteoporosis, hyperglycemia, weight gain, and adrenal suppression. 

Arachnoiditis Hope has been pursuing an alternative treatment for years and we are pleased to report we have discovered one.  Patients and physicians now have a choice. 

The New Alternative

1. Pregnenolone, 200 mg twice a day

2. Dehydroepiandrosterone, 200 mg twice a day

3. Palmitoylethanolamide, 600 to 1200 mg twice a day

Origin of the Treatment

Pregnenolone is a natural hormone made from cholesterol, primarily in the adrenal glands and the brain. Interestingly, pregnenolone was used as the main treatment for rheumatoid arthritis and lupus before corticosteroids were invented.

Pregnenolone and dehydroepiandrosterone (DHEA) are in the same class of natural hormones. They are called “neurosteroids” since they have a similar chemical structure to corticosteroids. However, they do not have the complications of corticosteroids. 

These neurosteroids are naturally produced in the central nervous system (CNS) to suppress inflammation, promote tissue restoration, and relieve pain. 

Palmitoylethanolamide (PEA) is another natural biochemical produced by the body to control inflammation, restore tissue, and provide pain relief. 

This new AA treatment can be initiated at any time. When taken together, these 3 medicinals have a potent anti-inflammatory, healing, and pain relieving effect. They can be used separately, but the three together are much more effective.

DHEA may cause hair loss or bleeding irregularities in pre-menopausal women. Reduce the dosage in these cases. Overall, there are far fewer side effects than corticosteroids.

New Handbook

To learn more about neurosteroids, please see my new handbook, “Primer on Neurosteroids and Chronic Pain Care.”

Neurosteroids are beneficial not just for AA patients, but for anyone with chronic pain, as they help heal damaged tissues, protect and regenerate nerves, and provide pain relief. 

There is a plethora of laboratory and human studies that pave the way to use neurosteroids in chronic pain care.

Their use in pain care improves pain control and lessens the need for opioids. 

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.    

Palmitoylethanolamide (PEA): A Natural Treatment for Intractable Pain

By Dr. Forest Tennant and Ingrid Hollis 

Palmitoylethanolamide (PEA) is a naturally occurring biochemical produced by the body for pain and inflammation control. It is also available as an over-the-counter dietary supplement. 

This article is presented with our belief that essentially every person with intractable pain should try a PEA supplement in a therapeutic trial.  Several companies market PEA supplements and researchers have determined effective dosages. 

PEA is the only medicinal that simultaneously fights inflammation at the site of an injury, as well as neuroinflammation in the central nervous system (CNS).  It helps heal damaged glial cells that are responsible for intractable or constant pain. 

About two dozen double-blind clinical studies have shown that PEA is more than just a placebo. German researchers say PEA is an effective and well-tolerated treatment for hundreds of patients with chronic pain.    

Our experience is not as extensive, but we have found that about 80% of patients experience good results if PEA is used for four to six weeks, providing relief for both chronic and intractable pain.  In most patients, PEA progressively wears down baseline pain. 

Starting dosage is 600 to 1200 mg twice a day.  This dosage can be increased if needed.  

Some PEA products contain luteolin, a polyphenol found in many fruits, vegetables and herbs that has anti-oxidant and anti-inflammatory properties. This is excellent as luteolin boosts the effectiveness of PEA, and also helps prevent the reactivation of the Epstein-Barr virus. 

One can simply add PEA to their current pain relief program.  Opioids and other pain medications need not be stopped. 

No serious side effects have been reported from taking PEA. As a natural biochemical, it is quite safe to take.  

If you have chronic or intractable pain, try a 1-to-2-month therapeutic trial of PEA. You have much to gain and nothing to lose. 

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.

Ingrid Hollis is a person in pain, patient advocate, and advisor to the Tennant Foundation.

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section. 

PEA: A Supplement That Helps Reduce Pain and Inflammation

By Julie Titone

It is a question I’ve long had but never bothered to look up: How do drugs get their names? Then I heard about palmitoylethanolamide and, given it has the longest name of anything I ever considered consuming, I had a solid reason to pursue the question.

PEA, as the tongue-twister is unsurprisingly known, isn’t a prescription drug. It’s a fatty acid found naturally in our bodies and in some foods. PEA can also be manufactured and is sold in over-the-counter supplements. It binds to cells in the body and reduces inflammation and pain.

When a fellow arachnoiditis sufferer called it to my attention, I read up on it.

PEA was first identified in the 1950s, after doctors observed that children who ate eggs were less likely to get rheumatic fever. Early studies found PEA not only in the fatty solids of egg yolks, but also in components of peanuts and soybean lecithin.

Researchers found that the compound had anti-inflammatory effects in animal models, and noticed it could also reduce allergic reactions. That lead to early clinical trials for conditions like influenza and the common cold.

Interest in PEA then dropped off for two decades. It was revived again thanks in large part to Nobel Prize-winning neurobiologist Rita Levi-Montalcini. Her work in the 1990s and 2000s helped establish PEA's role in modulating mast cells, which are key players in inflammation and allergic responses. She was a huge fan of PEA, reportedly taking it herself. She lived to be 103.

Interest in PEA is strong and getting stronger. For two recent reports, researchers analyzed scores of studies, tabulated the results of the rigorous ones, and reached upbeat conclusions.

The 2023 meta-analysis in the Swiss journal Nutrients looked at PEA’s effect on chronic pain, and found “PEA was associated with improved functional status and quality of life in many studies, while reported side effects were essentially negligible.”

A 2025 meta-analysis published by the journal Nutrition Reviews confirmed that “PEA effectively reduces pain and enhances quality of life, with significant benefits observed within 4-6 weeks of treatment. Palmitoylethanolamide is a promising alternative to chronic opioid analgesics, potentially reducing the risk of opioid abuse and dependency.”

That last point — that PEA could provide a safe alternative to opioids — is a big driver of interest in the nine-syllable compound. Researchers are also looking at its promise in treating long Covid, glaucoma, Alzheimer’s, Parkinson’s, ALS and more. So far, it’s shown to be most effective in the treatment of neuropathic pain.

To make PEA more effective, researchers have figured out how to make it more available in the body. Thus “micronized,” PEA is now available in some countries as a prescription drug. Why didn’t that happen earlier? For one thing, drug manufacturers apparently didn’t see great promise or profit in it.

Chemists also discovered PEA before the United States and WHO came up with national and international naming councils, which give drugs generic names such as ibuprofen.

Manufacturing marketing teams are the ones who come up with brand names. Though I find it hard to picture a room full of those folks looking at PowerPoint slides, rubbing their chins thoughtfully until someone exclaims “Yes! Let’s call it Advil! That certainly says ‘Be gone, demon headache’ to me!”

Am I taking PEA? Yes, dear reader, I am. For the past three weeks. Because the research says it takes four to six weeks to see results, I have nothing to report. Perhaps PEA won’t show definitive improvement, but works in the background to keep my inflammatory spinal disease from getting worse.

I would certainly take that outcome from a supplement that is readily available, doesn’t break the bank, and has no side effects.

Following a career in journalism and academic communications, Julie Titone writes about health, environment and other issues at julietitone.substack.com.