Epidural Cortisone for tx. of Arachnoiditis

[Melisa-An]

  Dear Dr. I am a RN and I was diagnosed with severe Aracnoiditis almost 2 years ago. When I was diagnosed, the Dr, called me on the telephone, told me I had this, told me it was incurable, and hung up! I was totally ignorant of this disease, even as a RN of 28 years. I thought that the physicians way of telling me was very poor. My Family Practice Dr. knew little about this disease. I subsequently was treated with one epidural cortisone injection that made the condition worse, not better. The Dr. had to stick me 5 times before he could get into the epidural space! I have since learned that this is contraindicated in the treatment of Arachnoiditis, as it can cause even worse scarring, or worse yet, also get into the sub-arachnoid space.Since all that, I have now bilateral pain in both lower extremities, and now pain in my thoracic area. I am also having pain now from neck to shoulder down both arms to my hands and fingers. I am also having bowel and bladder problems. In your opinion, is epidural cortisone a treatment modality that would be beneficial to tx. of this disease? Everything I have read seems to point to no. I learned about this disease, researching it myself. Thank you for your time and careful consideration. Sincerely, Melissa Ann, in Florida
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This is a very tough question to answer since the data regarding this problem is difficult to find. The first controversy revolves around the diagnosis itself, which can be difficult. Anything injected into the subarachoind space can lead to this problem. It is characterized by a combination of root and spinal cord symptoms that may mimic an intraspinal tumor. There is opacification and thickening of the arachnoidal membranes and adhesions between the arachnoid and dura.  Repeated corticosteroid injections have been implicated. In many cases no provocative factor can be recognized. For chronic adhesive arachnoiditis in which pain is the most ditressing symptom, there is no effective surgical or medical treatment. Administration of corticosteroids, systemic and epidural have usually not been found to be effective. In the early stages of arachnoiditis, corticosteroids have been given to control the inflammatory reaction and to prevent progress of the disease, but their value is questionable. I'm not sure how much this helps you and as you can see steroids have been used to treat but can also be a cause.
This information is provided for general medical education purposes. Please consult your doctor regarding diagnostic and treatment options of your specific medical condition.