Arachnoiditis: understanding and managing spinal inflammation

Back pain is something most of us experience at some point. Often, it's just a muscle strain from gardening or sitting too long at your desk. But what if your pain doesn't go away? What if it gradually worsens, accompanied by other concerning symptoms like numbness, weakness, or even bladder problems?

For some people, these symptoms point to a serious condition called arachnoiditis—a painful inflammatory disorder affecting the protective membranes surrounding the spinal cord. Though relatively rare, arachnoiditis can be debilitating, significantly impacting one's quality of life.

What exactly is arachnoiditis?

Arachnoiditis occurs when the arachnoid mater—one of three protective membranes covering the brain and spinal cord—becomes inflamed. This inflammation can lead to scarring and adhesion of nerve roots within the spinal canal.

Think of your spinal cord as a complex highway of nerves, each carrying vital messages between your brain and body. Now imagine these nerves becoming stuck together, unable to function properly. That's essentially what happens with arachnoiditis.

When spinal nerves sustain injury, specialised cells called glial cells trigger an inflammatory response. While inflammation is the body's natural healing mechanism, in arachnoiditis, this process goes awry, resulting in persistent inflammation that causes intense pain radiating from the lower back down to the legs.

Without proper management, the condition typically worsens over time, potentially leading to:

• Thickening of the arachnoid membrane
• Formation of scar tissue
• Clumping of nerve roots
• Disruption of cerebrospinal fluid (CSF) flow

In advanced cases, known as chronic adhesive arachnoiditis, scar tissue encapsulation may obstruct the normal flow of cerebrospinal fluid. This reduction in CSF flow can impair brain function and potentially lead to various neurological disorders.

Types of arachnoiditis

Understanding which type of arachnoiditis a person has helps medical professionals determine the underlying cause and develop appropriate management strategies. According to the Australian Arachnoiditis Sufferers Association NSW, a registered non-profit support group, there are six recognised types:

• Adhesive arachnoiditis: The most advanced form, characterised by nerve roots clumping together due to inflammation.
• Neoplastic arachnoiditis: Caused by cancerous processes affecting the spinal membranes.
• Arachnoiditis ossificans: A rare subtype where bone tissue replaces the arachnoid membrane.
• Cerebral arachnoiditis: Affects the protective membrane surrounding the brain, often causing severe headaches.
• Hereditary arachnoiditis: Associated with genetic disorders affecting the meninges.
• Optochiasmatic arachnoiditis: Develops behind the optic nerve and may cause vision impairment.

Recognising the symptoms

The symptoms of arachnoiditis typically develop gradually, with many people first noticing weakness in their legs. As the condition progresses, a constellation of symptoms may emerge:

Pain-related symptoms:

• Persistent burning or stabbing pain in the lower back
• Pain radiating down the legs
• Joint and muscle pain
• Burning sensations in lower limbs

Neurological symptoms:

• Numbness or tingling in extremities
• Muscle weakness or spasms
• Crawling sensation on the skin
• Dizziness or unsteady gait

Other systemic symptoms:

• Bladder or bowel dysfunction
• Sexual function problems
• Chronic fatigue
• Headaches and migraines
• Blurred vision
• Tinnitus (ringing in the ears)

In severe cases, arachnoiditis can lead to hydrocephalus (excessive CSF in the brain), intractable pain, neurological deficits and even serious disability. The impact on daily function can be profound, with many sufferers finding it difficult to stand for long periods or engage in normal activities.

What causes arachnoiditis?

Researchers initially linked arachnoiditis primarily to spinal surgery and myelography (a type of diagnostic imaging). However, further investigation revealed the picture to be more complex, as many patients undergoing myelography had already had previous spinal procedures.

According to research published in medical literature, several medical interventions and conditions may potentially trigger arachnoiditis:

Medical procedures:

• Spinal surgery (particularly laminectomy)
• Spinal or epidural anaesthesia
• Epidural steroid injections
• Lumbar puncture for CSF collection
• Neuroplasty or vertebroplasty
• Other invasive pain relief procedures

Other causes:

• Direct injury to the spine
• Infections (bacterial or parasitic)
• Exposure to certain chemicals or chemotherapy drugs
• Degenerative disc disease
• Spondylolisthesis (vertebral displacement)

It's worth noting that while these procedures are associated with increased risk, arachnoiditis remains a relatively rare complication.

Looking for natural approaches to arachnoiditis management? Explore natural treatments for arachnoiditis that may complement conventional medical care.

Diagnosing arachnoiditis: a complex challenge

Diagnosing arachnoiditis can be challenging because its symptoms overlap with many other nerve-related conditions. Doctors typically employ a combination of neurological examinations and advanced imaging to arrive at a diagnosis.

Common diagnostic tools include:

• Magnetic Resonance Imaging (MRI): Provides detailed images of soft tissues, helping to visualise inflammation, adhesions or clumping of nerve roots.

• CT scans: Offer detailed images of bone structures and soft tissues.

• Electromyogram (EMG): Measures electrical activity in muscles to assess nerve function.

• Clinical examination: Assessing pain patterns, sensory changes, reflexes and muscle strength.

Doctors may also need to rule out other conditions that cause similar symptoms, such as multiple sclerosis, peripheral neuropathy or herniated discs.

Managing arachnoiditis: a multi-faceted approach

While there's no cure for arachnoiditis, various strategies can help manage symptoms and prevent further complications. The key is understanding the specific cause and type of arachnoiditis to tailor the most effective treatment approach.

Pain management strategies:

• Medications: Anti-inflammatory drugs, pain relievers, nerve pain medications (like gabapentin or pregabalin) and muscle relaxants.

• Physical interventions: Physiotherapy, exercise programmes, spinal cord stimulation or transcutaneous electrical nerve stimulation (TENS).

• Surgical options: In select cases, surgical intervention may be considered to address specific structural issues, though surgery itself carries risks.

Complementary approaches:

• Lifestyle modifications: Ergonomic adjustments, pacing activities and stress management techniques.

• Physical therapy: Targeted exercises to maintain mobility and strengthen supporting muscles.

• Mind-body techniques: Meditation, mindfulness and relaxation techniques to help manage pain perception.

• Nutritional strategies: Anti-inflammatory diets and appropriate supplements under medical supervision.

A critical aspect of treatment is neuroinflammation suppression. Without addressing the underlying inflammation, pain can become centralised, potentially leading to additional conditions like hypertension, depression, anxiety, insomnia, fibromyalgia and vasoconstriction.

According to the Royal Australian College of General Practitioners, neuropathic pain (which includes arachnoiditis) often requires a multi-modal approach to management, combining both medication and non-pharmacological techniques. Their guidelines emphasise that early intervention can help prevent the development of chronic pain syndromes.

Living with arachnoiditis: beyond the physical pain

The impact of arachnoiditis extends well beyond physical symptoms. Living with chronic pain can take a significant toll on mental and emotional wellbeing, affecting relationships, work capabilities and overall quality of life.

Many people with arachnoiditis benefit from:

• Support groups: Connecting with others who understand the condition can provide emotional support and practical advice. Groups like the Australian Arachnoiditis Sufferers Association NSW offer both online and in-person support.

• Psychological support: Counselling or cognitive behavioural therapy can help develop coping strategies for living with chronic pain.

• Occupational therapy: Learning energy conservation techniques and adaptive strategies for daily activities.

• Disability accommodations: Working with employers or educational institutions to arrange necessary accommodations.

For Australians living with chronic pain, resources like Painaustralia and Chronic Pain Australia provide valuable information, support services, and advocacy. These organisations work to improve awareness, accessibility, and affordability of pain management services across the country.

Moving forward with arachnoiditis

While arachnoiditis presents significant challenges, many people manage their symptoms effectively with proper treatment. If you're experiencing back pain with neurological symptoms, consult your healthcare provider promptly—early intervention can significantly impact your prognosis and quality of life.

Remember, you're not alone in facing this condition. With appropriate medical support and lifestyle adjustments, many continue to lead fulfilling lives despite arachnoiditis.

Need help managing chronic pain? Explore structural integration practitioners who may assist with posture and movement as part of your treatment plan. Always consult your healthcare provider first.