Arachnoiditis is chronic inflammation of the arachnoid membranes that surround and protect the nerves of the spinal cord. The arachnoid become inflamed because of an irritation from chemicals, infection from bacteria or viruses, direct injury to the spine, chronic compression of spinal nerves, or complications from invasive spinal procedures. Inflammation can sometimes lead to the formation of adhesions, which cause the spinal nerves to stick together. If arachnoiditis interferes with the function of one or more of these nerves, it can cause a number of symptoms such as numbness, tingling, and a characteristic stinging and burning pain in the lower back. Arachnoiditis has no consistent pattern of symptoms, but it more frequently affects the supply to the lower back and legs. There may be an immune response that is suggestive of Chemically Induced Immune System Disorder. Arachnoiditis may be caused by:
• Myelographic dyes (oil-based- Pantopaque)
• Epidural steroid injections (Depo Medrol)
• Intraspinal drugs (anti-cancer drugs)
• Subarachnoid hemorrhage Spinal stenosis
Symptoms: Symptoms are diverse and present as a syndrome.
• Neurogenic (central) pains that arises from mild stimulus such as body
• Increased muscle tension with muscle spasms and spasticity
• Pains in various locations on your body (lumbar, buttocks, legs, feet, perineum,
hip, abdomen, arms, hands, neck, head, face, and chest)
• Sensitivity to temperature variations
• Easily fatigued (similar to PostPolio Syndrome)
• Autonomic nervous system dysfunction (blood pressure, temperature, bladder,
• Gastroparesis (delayed stomach emptying)
Diagnosis:
• Investigation of choice is T2 weighted, fat suppressed, gadolinium enhanced,
• MRI should be read by a neuroradiologist experienced with arachnoiditis
Treatment: Neurogenic pain syndromes are best treated by a pain clinic that specializes in arachnoiditis with a multidisciplinary approach. Chiropractic and nutritional support are part of the multidisciplinary approach. Chiropractic and nutritional support go hand in hand to aid the body in healing.
• Treatment is directed towards pain relief, decrease in symptoms, and
• Prescription drugs (muscle relaxants, antidepressants, anesthetics, narcotics,
• Herbs and nutritional supplements that crosses the blood brain barrier
Many intra·spine treatments such as steroid injections and medication via pumps and surgical intervention actually advance the arachnoiditis and is controversial as it generally provides only short-term relief. Prognosis: Arachnoiditis is insidious and incurable, but treatment decreases the symptoms and improves the person’s quality of life. Arachnoiditis varies from mild and non-progressive to a fulminating progression that may cause paralysis and even death. Progression after the first 24 months may be unlikely, but the onset may be years after the precipitating cause. www.cofwa.org
For treatment of type 2 diabetes Commissioning guidance: Commissioners may wish to bear the following in mind when considering the commissioning of dapagliflozin: Its place in the local care pathway should be defined by local Drug & Therapeutics or Area Prescribing In the absence of such local guidance, it is the opinion of the committee that dapagliflozin may be suitable
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