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SUPPORTIVE THERAPIES
FOR ARACHNOIDITIS
A HANDBOOK FOR PATIENTS & FAMILIES
By
Forest Tennant M.D., Dr. P.H.
338 S. Glendora Ave.
West Covina, CA 91790
626-919-0064
Fax: 626-919-0065
E-mail: [email protected]
Websites: www.foresttennant.com
www.hormonesandpaincare.com
January, 2016
Arachnoiditis is a rare disease that requires rare care.
This handbook accompanies a medical protocol for physicians, nurse
practitioners, and other health professionals. This document is
provided as a public service by the Tennant Foundation.
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TABLE OF CONTENTS
arachnoiditis
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No.
1 Preface
Document
Page
2
2
ArachnoiditisHow It Develops And Progresses
3
4
Finding Medication That Works For You
Three Legs Of Arachnoiditis Treatment
5
6
5
Do You Have Enough Pain Relief?
7
6
Sleep
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7
Spinal Cord Exercise
9
8
Improving Your Spinal Fluid Flow
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9
Dietary Supplements For Arachnoiditis And Cauda Equina Inflammation
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10
Diet For Centralized Pain Patients
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Electricity Elimination
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Catecholamine Drugs For Severe, Intractable Pain
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Pain Relief Drugs For Centralized Pain Patients With Constant Pain
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How An Arachnoiditis Patient With Constant Pain Must Take Their Pain Medication
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Neuroinflammation: The Missing Link
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16
The Importance Of Spine Bracing
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Control Of Neuroinflammation: The Arachnoiditis Patient’s Major Challenge
How And Why To Use Ketamine?
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Your Life-Lines: Walking and Stretching
3-4
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20-21
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PREFACE

This handbook contains supportive therapies that have been found helpful over several
years by our cauda equina inflammation (CEI) and adhesive arachnoiditis (AA) patients

Many of the recommendations here are century-old remedies that are time-eternal but
still useful. Also, many of the recommendations here are not generally known or
accepted by the scientific establishment

Information here may be shared with any CEI or AA patient and family as these
conditions may be rapidly progressive and have disastrous disabling consequences
This handbook is dedicated to my early, instructive and afflicted patients who
persevered: Gary, Michael, Marjorie, Melody, Joe, Kimberly, Radine, James, Leslie.
The medical protocol that accompanies this handbook has been
developed by treating arachnoiditis patients over several years. It,
like other medical protocols, is to provide a standard regimen that
is safe and effective for the majority of patients. There are several
components to the protocol. Not all will be effective for every
patient as the purpose of a protocol is to attempt enough different
treatments to provide some relief and recovery to all patients. The
protocol and this handbook are constantly being updated as new
therapies are being investigated.
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ARACHNOIDITISHOW IT DEVELOPS
AND PROGRESSES
Arachnoiditis simply means inflammation of the arachnoid lining of the thecal sac. Adhesive
arachnoiditis means that the arachnoid layer has adhered or glued itself to nerve roots or the
spinal cord.
The above definitions do not describe the usual pathologic process that precedes the tragic
development of adhesive arachnoiditis. The actual disease process begins with nerve root or
“cauda equina” inflammation. Only when inflamed nerve roots stick or adhere (forming an
adhesion) to the arachnoid lining does “arachnoiditis” occur. Some patients who are diagnosed
as arachnoiditis or have the symptoms of this condition only have nerve root inflammation and
have not progressed to the point that the nerve roots have adhered to the arachnoid lining.
This does not necessarily mean that symptoms and impairments are less or that aggressive
treatment is not needed.
MRI INTERPRETATION
Magnetic resonance imaging (MRI) studies are often
not interpreted by radiologists as showing the presence
of arachnoiditis even though the patient has all the
symptoms. This is usually because the nerve roots are
in the inflammation and clumping stage but have not
yet adhered themselves to the arachnoid lining. Nerve
root or cauda equina inflammation can often be,
however, observed on an MRI since inflammation
causes edema (swelling), displacement, and the
adherence or clumping of nerve roots to each other.
DANGER OF NEUROINFLAMMATION
Make no mistake about nerve root inflammation. It is
extremely painful, debilitating, and progressive. A
major reason for this short education piece is to
broaden the understanding of nerve root inflammation,
expand MRI interpretation, and, most of all, call for
more aggressive treatment of nerve root inflammation.
Simply put, if nerve root inflammation is not stopped,
the nerve roots will clump together in a mass (tumorlike) and cause severe pain and dysfunction of the
nerves that connect to the stomach, intestine, sexual
THE ANATOMICAL SETTING FOR CAUDA
EQUINA INFLAMMATION
The pathologic process that leads to
arachnoiditis can occur due to the
anatomic make-up of the spinal cord
and nerve roots. The spinal cord itself
goes from the brain down the vertebral
canal to about the first lumbar vertebra.
The end is cone-shaped known as the
“conus medullaris”. About 2 dozen
string-type nerves known as nerve roots
or collectively as the “cauda equina” (in
Latin this means horses tail due to the
visual similarity) originates from the
conus and trail downward to the
sacrum. These nerve roots are encased
in a protective sac known as the thecal
sac. Its lining is called the dura mater,
and the inner-most layer is the
arachnoid. Within the thecal sac is the
cerebrospinal fluid which is there to
nourish the nerve roots and wash away
toxic materials such as tissue particles
that may result from inflammation. The
small nerve roots are always in fluid and
protected by a covering.
Any
contaminant or irritant that enters this
protected area may set-up an on-going
inflammatory process.
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organs, pelvis, legs, and feet. The clump retains electricity, interferes with nerve conduction,
interferes with flow of spinal fluid, and produces toxic, inflammatory by-products that create a
systemic (“all-over”) autoimmune condition. The retained electricity and impairment of nerve
conduction leads to such symptoms as sweating, hot flashes, jerking legs, and burning feet. The
mass of clumped nerves may also cause some blockage of cerebrospinal fluid flow that can
produce headaches, blurred vision, and pain behind the eyes. All these symptoms may occur
without the arachnoid layer actually being adhered to inflamed nerve roots.
NECESSITY OF EARLY DIAGNOSIS
Patients tend to respond much better to treatment if they only have inflamed nerve roots and
have not yet progressed to adhesion formation with the arachnoid lining. Cauda equina nerve
root inflammation is analogous to the inflammation of rheumatoid arthritis in a joint. If it is not
controlled by aggressive medical management, the joint will progressively be more painful,
deformed, and destroyed. The same process occurs with the nerve roots in the spinal canal.
INCREASING HOPE FOR THE FUTURE
The term “arachnoiditis” will continue to be used to encompass both patients who show nerve
root adhesion to the arachnoid layer as well as those patients whose nerve roots are inflamed
and pathologically clumped together. Arachnoiditis is still listed as a rare disease on the “Rare
Disease Registry”, and it is recognized enough to have its own “International Classification of
Disease” code number (ICD-10, G 03.9). In the past it has been thought to be a “hopeless”
disease for which only symptomatic treatment could be done. Our new understanding of nerve
root inflammation, autoimmunity, centralized pain, electromagnetism, and the neurohormones
have given us the tools to greatly control arachnoiditis and nerve root inflammation just as we
do with rheumatoid arthritis. A medical protocol to treat arachnoiditis has been developed for
outpatient, medical practitioners and it will be made
available on request. Every patient with arachnoiditis
can and should now get enough relief and recovery to
have a meaningful, quality of life without suffering.
“Our mission is to bring
ARACHNOIDITIS EDUCATION PROJECT
THE TENNANT FOUNDATION
334 S. GLENDORA AVE.
WEST COVINA, CA 91790
Ph: 626-919-7476
Fax: 626-919-7497
E-mail: [email protected]
arachnoiditis treatment
to every community”.
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FINDING MEDICATION THAT WORKS FOR YOU
You are being treated with a “medical protocol” which means you are
prescribed or issued 4 to 8 medications at one time. Not all are
expected to help and some may cause side-effects.
CRITICAL ACTIONS TO TAKE
1. Stop any medication that has side-effects, agitates you, or causes
increased pain.
2. Stop any medication after 1 month if you are not getting any
positive benefit from it.
3. Continue medications you believe are helping you.
4. Report all positive and negative experiences to the clinic.
GOAL: FIND 2 OR 3 EFFECTIVE MEDICATIONS OUT OF EVERY 5 YOU
TRY.
BACKGROUND: Non-standard medications and medical measures are
only administered when the standard ones fail to achieve pain relief
and control the inflammation of CEI and AA. No guarantee can be
made as to the safety and effectiveness of non-standard medications.
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THE THREE LEGS
OF ARACHNOIDITIS
TREATMENT
PAIN RELIEF
NEUROINFLAMMATION
CONTROL
NEUROGENESIS
The 3 “legs” must be simultaneously administered
to be optimally effective.
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DO YOU HAVE ENOUGH
PAIN RELIEF?
Without enough pain relief, you can’t expect the anti-inflammation
and neurohormone regeneration elements of the medical protocol
to help much.
Excess pain eliminates the ability of nerve roots to regenerate.
Here is how to know you have enough pain relief:
1. You must have enough pain relief to get out of bed between
6:00 and 7:00 am. Keep your pain medication next to your
bed and take it immediately when you awake each morning.
Your first dosage should be before 7:00 AM.
2. You must be out of bed and doing normal activities of daily
living before 8:00 am. The natural hormones of the body
are at their highest peak between 6:00 and 10:00 am. It is
critical that you are active at this time every day because
these are the hours that the body does most of its healing
and regeneration.
3. Take your last dosage of pain medication within 1 hour of
going to bed. If you awake with pain during the night, take a
dose of pain medication.
KET POINT: IF YOU DON’T HAVE ENOUGH PAIN RELIEF TO GET OUT OF
BED BETWEEN 6:00 AND 7:00 AM EACH DAY, YOU NEED MORE OR
BETTER PAIN MEDICATION.
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SLEEP
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A regular sleep pattern enhances the hormone and immunologic
systems that are necessary for neurogenesis.
 Be in bed between 10:00 and 11:30 PM.
 Do your last stretches and medication dosage 30 to 60 minutes
before bedtime.
 Keep your pain medications beside your bed. Take additional
dosages during the night, if necessary.
 Take your first morning pain relief medications to be out of bed
between 6:00 and 7:00 AM.
 Goal is 4 to 8 sleeping hours. Do not expect more than four hours
of consecutive sleep.
 Most popular sleep aids are zolpidem (Ambien®) and temazepam
(Restoril®).
 Take melatonin 5 to 10 mg with your sleep aid to assist sleep and
help regulate your hormone and immune systems.
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SPINAL CORD EXERCISE
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FULL-BODY STRETCH LAYING DOWN
Lay down on the floor and do a full-body stretch. Count up to 10.
FULL-BODY STRETCH STANDING
Spread hands and reach “to sky” until you feel pressure and tugging in your
back. Count up to 10.
SIT AND STRETCH ARMS
Stretch your arms and spread your fingers. Count up to 10. Can do while
sitting in a car or plane.
LEG RAISE WHILE LAYING DOWN
Raise leg until you feel tugging in your back. Count up to 10.
LEG RAISE WHILE STANDING
Stabilize yourself next to a table or wall. Raise your leg and flex your foot.
KNEE PULL WHILE LAYING DOWN
Pull knee back until you feel tugging in your back. Count up to 10.
INVERSION TABLE
If able, a short episode on an inversion Table may assist in pulling adhesions
and cauda equina nerves apart to preventing scarring and allow electricity to
pass.
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IMPROVING YOUR SPINAL FLUID FLOW
 Arachnoiditis and cauda equina inflammation commonly cause spinal
fluid flow obstruction. When spinal fluid is obstructed you may get
these symptoms among others:






Headache
Blurred vision
Inability to think or read
Weak legs
More pain
Bladder and bowel function worsens
 Even worsethe spinal fluid cannot carry away inflammatory
particles generated by the inflamed nerve roots. This retards
healing. Another function of spinal fluid is to bring nutrients from
your food to the nerve roots in the cauda equina. This function may
also be impaired. You must do some of the following each day:
 Rock in a rocking chair
 Walk on a trampoline
 Use vibrator or massager over spine (Back scratchers and scrubbers are
terrific)
 Soak or wade in water
 Walk and swing your arms (“Power Walking”)
 Rock back and forth on your feet
 Rub your spine with copper and a magnet
 Nod your head up and down
 Scrub you back with a brush
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DIETARY SUPPLEMENTS FOR ARACHNOIDITIS
AND CAUDA EQUINA INFLAMMATION
Our experience has shown that few dietary
supplements are effective in our patients.
We highly recommend these 3.
 Vitamin B12  Once or twice weekly. Can be sub-lingual (under
tongue) or injectable.
 Taurine  1000 to 2000 mg a day
or
L-glutamine  1000 to 2000 mg a day
Take taurine and glutamine on an empty stomach with any fluids.
Below are listed dietary supplements that have been reported to
sometimes be effective in some patients. If you attempt any of these,
do so for only a month and stop them unless you believe they really
help you.







Vitamin D
Folic acid
Magnesium
Tyrosine
Carnitine
Curcumin
Vitamin C
Taurine and glutamine make gamma amino
butyric acid (GABA) which is the natural
electricity conductor in nerves. If you lack
GABA you will have more pain.
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DIET FOR CENTRALIZED PAIN PATIENTS
PROTEIN
It provides the amino acid building blocks that are necessary for the production of
neurotransmitters and tissue healing.
YOU MUST EAT SOME OF THE FOLLOWING EACH DAY
FISH
PORK
CHICKEN
EGGS
TURKEY
COTTAGE CHEESE
BEEF
If you can’t or won’t eat any of the above you must obtain protein powder drinks and/or
protein bars from the health food store.
VEGETABLES AND FRUITS
Some vegetables and fruits have anti-inflammatory activity. Eat some of these each day.
CARROT
BROCCOLI
RADISH
BLUEBERRY
APPLE
CELERY
BRUSSEL SPROUTS
ONION
BLACKBERRY
BEETS
SPINACH
LETTUCE
RASPBERRY
TOMATOES
CUCUMBERS
WATERMELON
STRAWBERRY
DRINKS (Only use dietary sugars if weight is a problem)
COFFEE
TEA
DIETARY SODAS
WATER
Low dose, occasional alcoholic drinks are acceptable.
BANNED TO CONTROL WEIGHT
MILK
REGULAR SODAS
FRUIT JUICE
BREAD, ROLLS, BUNS
HIGHLY RESTRICTED TO CONTROL WEIGHT (Eat these very sparingly)
POTATOES including FRENCH FRIES
CAKES/PIES
CORN
PASTA/PIZZA
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ELECTRICITY ELIMINATION
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A major problem with clumped or trapped nerve roots is that electricity
does not pass as it normally should. It builds up – causes increased
inflammation – and then it may suddenly release itself in dysfunctional
bursts. This is why patients get:




Shooting and burning episodes of pain
Legs jerk and tremor
Feet burn
Temperature rises with sweating
When you daily do measures to control and eliminate your retained or
trapped electricity, you not only suppress painful and troublesome
symptoms, you reduce inflammation and promote healing and nerve
regeneration. Here are routine measures. Do some daily.








Rub your spine with copper or magnet
Wear copper anklet or bracelet
Use magnets in your shoes or mattress
Wear lots of jewelry
Hold door knobs or other metal a second longer
Soak in water (Epsom salts help)
Pet your dog or cat (Any fur will do)
Walk barefoot on carpet or outside on your lawn
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CATECHOLAMINE DRUGS (StimulantType) FOR SEVERE, INTRACTABLE PAIN
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The adrenal gland produces a set of hormones called catecholamines.
They include adrenalin, norepinephrine, and dopamine among others.
These hormones control the “descending pain pathways”.
EXAMPLES OF ADRENERGIC DRUGS
1. Methylphenidate (Ritalin®) – 5, 10, 20 mg
2. Dextroamphetamine – 5, 10 mg
3. Amphetamine Salts (Adderal®) – 5, 7.5, 10, 20, 30 mg
4. Phentermine – 37.5 mg
If you have severe, centralized pain from Arachnoiditis, RSD/CRPS, PostViral Syndrome, Traumatic Brain Injury, or other cause, you will almost
always need a catecholamine drug for adequate pain relief.
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PAIN RELIEF DRUGS FOR CENTRALIZED
PAIN PATIENTS WITH CONSTANT PAIN
For decent, pain relief you will likely have to take a drug in each category.
OPIOIDS
TRAMADOL
HYDROCODONE
OXYMORPHONE
MORPHINE
CODEINE
LEVORPHANOL
TAPENTADOL
METHADONE
HYDROMORPHONE
OXYCODONE
N-METHYL-D-ASPARATE RECEPTOR STABILIZER
KETAMINE
NEUROPATHIC AGENTS (Blocks Pain Signals)
TOPRIMATE
GABAPENTIN
CARISOPRODOL
DIAZEPAM/CLONAZEPAM/ALPRAZOLAM
PREGABALIN
ADRENERGIC AGENTS (Replaces adrenalin, dopamine, norepinephrine)
METHYPHENIDATE
DEXTROAMPHETAMINE
AMPHETAMINE SALTS
PHENTERMINE
MODAFANIL
TIME TABLE FOR REGULAR ADMINISTRATION
1st Dose
2nd Dose
3rd Dose
4th Dose
6:00-8:00 AM
10:00-NOON
4:00-6:00 PM
8:00-10:00 PM
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HOW AN ARACHNOIDITIS PATIENT
WITH CONSTANT PAIN MUST TAKE
THEIR PAIN MEDICATION
1. POTENTIATION: All pain relief medication including opioids (e.g. oxycodone,
hydromorphone, tramadol, etc.) and non-opioids (e.g. gabapentin, ketamine,
dextroamphetamine) should be taken together, at the same time.
2. STOMACH PROTECTION: Pain medications should be taken with a liquid
antacid (e.g. Pepto-Bismol or other) to prevent stomach upset.
3. DOSAGE TIMES: The time to take medication must be 4 times a day, every 4 to
6 hours while awake. Here is your dosing schedule.
1st Dose
6:00-8:00 AM
2nd Dose
10:00-NOON
3rd Dose
4:00-6:00 PM
4th Dose
8:00-10:00 PM
4. LONG-ACTING OPIOIDS: If one of your medications is a long-acting opioid (e.g.
Nucynta®, Oxycontin®, methadone) they should only be taken with your 1 st
dose (6 to 8:00 AM) and last dose (8-10:00 PM). If you currently take a patch
opioid, continue it but work to stop it, unless you can’t take oral opioids.
5. MEDICATION BETWEEN DOSAGES: It is acceptable to take a non-pain relief
medication such as an anxiety, dietary supplement, hormone, or anti-nausea
medication in-between pain medication dosages.
6. EMERGENCY OPIOID DOSAGES: It is acceptable to take an opioid in between
your regular pain medication dosage times, but this should only be for
emergency use. If you are having breakthrough pain between your regular
dosages, you need to increase the potency of your 4 regular dosages. Topical
(skin rub) pain relievers including patches can be taken between regular
dosages. Also, use your magnet between dosages.
7. SLEEP ISSUES: Your last pain medication dosage is to be taken between 8:00
and 10:00 PM which should be within 1 hour of your bedtime. Take any sleep
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medication you need 30 to 60 minutes before you lay down to sleep. If pain
awakens you during the night, you can take a full or partial dose of your pain
medication. Keep your pain medication at your beside and take your first pain
medication when you awake in the morning. DO NOT take medication when
lying down. Only take it when sitting, or best when standing. Your first
medication dosage is best taken before 7:00 AM and NEVER later than 8:00
AM.
8. SIDE EFFECTS: If one of your pain medications makes you sedated, itchy,
nauseated, or has other side-effects, you must simply stop it and find another.
9. KEYS TO UNDERSTAND: Pain relief drugs taken together “potentiate” or make
their potency more effective than when taken alone. For example, tramadol
taken with Percocet® or Norco® makes as potent pain reliever as there is. You
must keep your total daily opioid dosage at a level that your local, communitybased, primary care physician or nurse practitioner will prescribe, a local
pharmacy will fill, and your insurance plans will cover. You cannot rely on pain
specialists, neurologists, or other specialists to prescribe high dose opioids, for
pharmacies to stock them, or insurance to pay for them. Due to regulatory
restrictions, cost, and lack of medical pain specialists you cannot rely on high
dose opioid drugs.
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NEUROINFLAMMATION
THE MISSING LINK
The reason that arachnoiditis sufferers have not been able to get much help is because medical
science did not realize that the central nervous system creates an inflammation that has unique
characteristics compared to that in joints and muscles. It is formed by the microglial cell, and it
does not respond or suppress much, if at all, to standard anti-inflammatory drugs or
hydrocortisone.
SPINAL CORD INFLAMMATION: Arachnoiditis is basically inflammation of the lining of the spinal
covering. Adhesive arachnoiditis is when some of the spinal nerve roots in the cauda equina or
the spinal cord adheres or attaches to the lining because of inflammation. Nerve roots of the
cauda equina which become inflamed show swelling, enlargement, clumping, and displacement
on MRI.
SYMPTOMS AND CHARACTERISTICS OF SPINAL CORD INFLAMMATION:
PAIN
FATIGUE
SWEATING/TEMPERATURE
SUDDEN FLARES
SCARRING
PROGRESSIVE CLUMPING/PARALYSIS
INFLAMMATION ACCUMULATES: Neuroinflammation constantly builds up and then may
suddenly “strike” with a severe pain flare or more paralysis. Worse, it continues to create
clumping and scarring.
REASON FOR FAILURE: Arachnoiditis patients naturally want to focus on relief of pain, fatigue,
and paralysis. We now realize that any medication for pain or even hormonal treatment is only
marginally effective UNLESS spinal cord inflammation is first controlled.
DIFFICULT TO CONTROL SPINAL CORD INFLAMMATION: We have identified only 2 drugs which
we believe reliably control spinal cord inflammation. We believe that diet, magnet-copper
application, and certain spinal cord exercises may help, but they are insufficient to fully control
spinal cord and arachnoid inflammation.
PREVENTION OF BUILD UP: Every arachnoid patient must have a daily regimen to keep
neuroinflammation from accumulating. This has been the missing link to relief and recovery.
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THE IMPORTANCE
OF SPINE BRACING
Shockingly, few arachnoid or spinal cord inflammation patients are told
they need to periodically wear a brace to protect their damaged area.
WORST SITUATION: Riding in a car on plane that has bucket seats.
DANGER SITUATION: Walking in unfamiliar areas such as a shopping
center, grocery store, or social event.
Always wear a back brace to protect yourself in the above situations.
MOST IMPORTANT TIME TO WEAR A BACK BRACE:
PAIN FLARE
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CONTROL OF NEUROINFLAMMATION:
The Arachnoiditis Patient’s Major Challenge
THE PROBLEM
It is now clear that the microglial cell in the nervous system may create chronic
neuroinflammation that can destroy cellular tissue, produce scar formation, adhesions, and be
progressive. As cellular tissue is destroyed, waste products are formed which may get into the
general circulation and cause autoimmune manifestations such as muscle aches and joint pains.
When neuroinflammation accumulates or new cellular tissue is destroyed, a severe pain flare
will occur.
THE SCIENTIFIC NAME
The term “arachnoiditis” literally means inflammation of the arachnoid lining of the spinal cord
covering (thecal sac). This is too simplistic. The scientific name should be “cauda equina
inflammation” to indicate that not only is the lining of the covering inflamed but so are some of
the nerve roots in the cauda equina. It is inflammation
of the nerve roots that may spread to form adhesions,
scars, and impairment of nerves that lead to the
bladder, bowel, stomach, sex organs, and legs.
Always assume that a severe pain
flare means active neuroinflammation
TREATMENT STRATEGY
that is destroying additional tissue.
An arachnoiditis patient must have 2 basic strategies
to control neuroinflammation: (1) daily and chronic
suppression of neuroinflammation; and (2) aggressive
control of severe pain flares.
SPECIFIC TREATMENT
To date we have identified only 2 pharmacologic agents to predictably help control the
neuroinflammation of arachnoiditis: (1) Ketorolac (Toradol); and (2) Synthetic corticosteroid
(methylprednisolone, prednisone, or dexamethasone).
While we have observed that some other agents may sometimes suppress the
neuroinflammation of arachnoiditis, but these 2 have been the only ones that have been
consistently effective.
OUR BASIC RECOMMENDATION
1. Ketorolac (Toradol), an injection of 30 to 60 mg, 1 time a week
SPECIAL NOTES: Must not be taken daily. Oral ketorolac in our patients has caused too
much gastric upset and bleeding episodes. Patients who use ketorolac must have a kidney
test every 90 days to detect any adverse effect on the kidney.
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2. Corticosteroid:
a. methylprednisolone 2 to 4 mg
b. prednisone 5 - 10 mg
Take at 3:00 to 4:00 PM each day. May take it with DHEA (25 to 50 mg) for extra
effectiveness and protection against any possible side-effects.
Limit the corticosteroid to 5 days a week to protect against side-effects.
TREATMENT OF SEVERE PAIN FLARES
This usually requires a combination of these drugs:
1. Methylprednisolone
2. Hydromorphone
3. Ketorolac
PREVENTION OF SIDE-EFFECTS
The measures recommended here have not, to this date, shown any irreversible side-effects.
At this time the benefits of neuroinflammation control appear to far outweigh the risks of the
measures outlined here. The neuroinflammation associated with arachnoiditis leads to so
much disabling pain and serious complications that some risks are warranted.
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HOW AND WHY TO USE KETAMINE
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WHY?
Ketamine acts at a special receptor in the central nervous system which is critical
for pain control. This receptor is not acted upon by opioids and neuropathic
drugs. This receptor is known as the N-methyl-D-aspartate receptor commonly
abbreviated NMDA. Good pain control in centralized pain requires: (1) opioid; (2)
neuropathic agent, and (3) an NMDA agent and sometimes a (4) catecholamine
agent.
FORMULATION
We initially use a sublingual preparation although oral capsules can later be used.
First issue is 60 ml of 40 to 60 mg/ml.
DOSAGE AND FREQUENCY
We initially start at a very low dosage to avoid side-effects. The dosage is raised
over a 2 to 6 week period.
INITIAL DOSING
1. 10-15 mg sublingual at 7:00 AM, Noon, 5:00 PM, and 10:00 PM
2. After 1 week raise the dosage to 15 or 20 mg at the times listed above
3. In the 3rd week raise the dosage to 25 mg at the times listed above
MAINTENANCE DOSAGE
1. 25 mg, 4 times a day by sublingual route
2. Oral capsules will require 30 to 50 mg a day
We now view ketamine as an essential agent in treatment of arachnoiditis.
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YOUR LIFE-LINE
WALKING AND STRETCHING
To keep the inflamed nerve roots from forming adhesions and scars,
you must walk and stretch every day.
When you walk, swing your arms (“power walk”) at times.
But don’t overdo! Stop walking when you feel tired or if pain is
starting.
Never stretch and cause pain.
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