Arachnoiditis tough to control

January 29th, 2010

DEAR DR. GOTT: My wife was diagnosed with arachnoiditis about three years ago. Our doctor has her on a fentanyl patch, Neurontin, Norco and Flexeril at bedtime. These medications seem to keep things in check for reducing her pain, but sometimes she will get a flare-up and nothing seems to work. Her doctor put her on prednisone for short periods, which worked well and almost made her euphoric; however, when she isn’t on the prednisone, her feet become callused, crack, bleed and become painful.
Have you run into this before with your patients? If so, what is out there in the way of new technology to help the situation? Any new studies being done?
DEAR READER: Arachnoiditis is a disorder caused by inflammation of the arachnoid, a membrane surrounding and protecting the nerves of the spinal cord. The inflammation can result from a bacterial infection or virus, injury, chronic spinal-nerve compression, chemical irritation or any invasive procedure, such as surgery.
The condition can present with stinging and burning of the lower back or legs, muscle cramps, spasms and pain. Bladder and bowel abnormalities, as well as sexual dysfunction, might also occur. Any prior disorders of the spine or aging can complicate or impede progress.
Treatment is commonly directed toward the relief of pain. Management might be accomplished through exercise, physiotherapy or psychotherapy and, as you have discovered, steroids. Surgical intervention remains controversial because of the less-than-optimal outcome and the fact that pain relief is temporary. She might consider speaking with her physician about visiting a pain clinic, undergoing acupuncture, or attending water-aerobics or yoga classes. Treatment outcomes vary from person to person, so what works for one person might not be successful for another. The condition remains difficult to manage.
Her physician has her on several high-powered medications for pain control, and Flexeril, a muscle relaxant commonly used for acute muscle spasms, pain or injury. It is common for feet to crack, bleed and hurt like the dickens when dry. Perhaps your wife’s problem is the result of a medication or the combination of drugs she is on. In any event, this condition can often be controlled with a mentholated chest rub or even plain petroleum jelly available in pharmacies. Simply have her lather a generous amount of the ointment on her feet then slide them into white cotton socks before retiring for the night. The medicated salves should work their magic by morning and provide welcome relief.
Finally, the National Institutes of Health performs clinical trials for this and a number of other medical conditions. She might wish to contact them to determine whether she qualifies for a program related to arachnoiditis. They can be reached through their Web site at www.ninds.nih.gov.
Because I edited your letter due to space limitations, I am also passing on your recommendation of the Circle of Friends with Arachnoiditis’ support-group Web site, www.cofwa.org. Perhaps this information will assist other readers in coping with this extremely painful condition.
To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.