What is Peripheral
Peripheral nerves are those
nerves that are not found within the spinal cord. In peripheral
neuropathy there is damage to the nerves causing dysfunction and sensory
loss. Symptoms are usually found in the limbs and may include sensations
such as pain, pins and needles, numbness, a burning sensation, weakness,
and in some instances paralysis.
When many nerves are
involved the syndrome is called polyneuropathy. There are many causes of
peripheral neuropathy, however the cause may not be known. Diabetes,
trauma to the nerves, microorganisms, nutritional deficiencies,
medications and toxins are among some of the causes.
Neuropathy can be treated
and in some cases even cured. The type of treatment depends on the
cause. Research is needed to find more effective treatments. For more
detailed information, consult the Merck Manual
What is the difference
between arachnoiditis and epidural fibrosis?
chronic inflammation inside the dura, in the arachnoid layer of the
meninges...whereas epidural (peridural, extradural) fibrosis is scarring
outside the dural sac. It may also be referred to as
"adhesions" or "scar tissue".
"Many doctors appear
to regard epidural fibrosis as less clinically significant than
arachnoiditis, but in essence the nerve root compression arising from
epidural fibrosis may cause similar clinical problems in terms of lower
limb pain, sensory disturbance and weakness."
differs from arachnoiditis in that it is more likely to be a localized
problem and is generally a post-surgical phenomenon, although it may
also be a sequela to invasive procedures such as chemonucleolysis. In
cases of arachnoiditis, there is often associated epidural fibrosis, but
the reverse is not generally acknowledged, so that patients may be left
with a diagnosis of epidural fibrosis and are unable to get a diagnosis
of arachnoiditis even when the clinical picture fits. Arachnoiditis is
an underdiagnosed condition." - Sarah Smith, MD
myelogram dyes cause arachnoiditis?
For the answer we incude
the following quotes:
Study by IHJ Bourne, MD
In the Journal of the Royal
Society of Medicine Vol. 83 April l990 titled Lumbo-sacral Adnesive
arachnoiditis: a review, in the introduction, the fourth paragraph says:
"In spite of the
fact that oil-based iodine agents have been abandoned there is still
the risk that water-based iodine preparations will in some way cause
arachnoiditis . The present trend towards the use of non-invasive
electronic scanning techniques brings hope that myeolgraphy using
iodine-based media or indeed any other medium will become a thing of
the past." Study by IHJ Bourne, MD
In his article entitled
Adhesive Arachnoiditis: Water-Soluble Myelography Dr. Charles Burton,MD
reports the following regarding the incidence of adhesive arachnoiditis
from water-soluable dyes:
"It is quite small
with the water-soluable contrast agents, particularly with the
non-ionic agents. This is not to say that the water-soluable agents
haven't been associated with significant adverse reactions; their
problems, however, have been of a different nature and typically
reflect acute nerve cell and meningeal reaction. These reactions tend
to be minimal but if the wrong water-soluable agents, or the wrong
concentrations of agent, are administered there can be serious
consequences such as permanent neurological injury or death."
For the complete article
please click here.
What can I do to get
As there is no known cured
for arachnoiditis you should aim to achieve the best quality of life in
1. Knowledge is
empowerment - learn all you can about the condition.
2. Be in contact with
others who have arachnoiditis, to share information and experiences
and to provide mutual support.
3. Follow a pain
management programme provided by a multidisciplinary team at a pain
clinic. Your GP should liaise with the pain clinic.
4. Learn to pace yourself
according to the level of pain and extent of other disabilities and
avoid activities and situations that lead to flare ups.
5. Never give up hope of
spontaneous improvement and of discovery through research of better
ways to treat arachnoiditis.
6. Remain positive, gain
control over the situation and use it creatively for some meaningful
Where can I go for help?
What type of doctor deals with arachnoiditis?
Several types of
specialists deal with arachnoiditis - neuro and orthopedic surgeons,
neurologists, rheumatologists, pain specialists (anesthesiologists with
additional training in management of pain).
The best place to get help
is a pain clinic. A pain management programme is prepared for each
individual after an initial assessment by a multi disciplinary team
headed by the pain specialist and including a physiotherapist,
occupational therapist, psychologist, and ideally a neurologist. Regular
follow up visits allow for evaluation of the effectiveness of the
programme and monitoring of the neurological status. In between these
visits your General Practioner (GP) will prescribe the recommended
medications and should liaise with the pain clinic team as necessary.
Are there any surgeries
that can fix arachnoiditis?
No surgical procedure can
Removal of the scar tissue
by meticulous micro dissection may give temporary relief from pain but
the process will inevitably start up again. Some complications of
arachnoiditis can be dealt with surgically eg removal of arachnoid cysts if they are causing compression of
the spinal cord and nerves;
drainage of a syrinx (a fluid filled cavity within the spinal cord which
can also add additinal symptoms).
Is there a cure for
There is no known cure for
Why am I so tired all
Persistent tiredness, or
chronic fatigue, is experienced in many chronic disease states eg ME,
Fibromyalgia, Gulf War Syndrome, Multiple Sclerosis, chronic infections
such as tuberculosis, and also in chronic pain states and chronic stress
for any cause. At the Collaborative Pain Research Unit in Australia
studies have shown that in these illnesses there is ongoing activation
of the immune defence system. Cells become depleted of amino acides
resulting in fatigue and pain. Muscle protein is broken down to get the
amino acids resulting in fatigue and pain. Muscle protein is broken down
to get the amino acids needed by other cells.
In arachnoiditis there is
additional breakdown of muscle cells because of the constant muscle
activity from spasm, cramps, fasciculations ("rippling" of
muscles), involuntary jerks, etc. A healthy person feels tired after a
lot of physical activity such as walking, exercising, running, household
chores, etc. but feels better after rest, especially after a night's
sleep when the body replenishes the used up reserves of energy. Those
with arachnoiditis who have constant muscle activity during the day and
night (when it is often worse) will be permanently tired since there is
no opportunity for a build up of the depleted energy reserves. Add to
this the chronic inflammatory state in the spinal canal, thought to be
the result of an overactive immune defence system, the chronic pain, and
the associated stress in coping with pain and disability, then all the
ingredients are in place for permanent tiredness and lack of energy.
NB The Collaborative Pain
Research Unit studies were reported in the NSGP, 22 March 2000.
Are bladder and bowel
problems associated with arachnoiditis?
Arachnoiditis in the
lumbosacral region of the spinal canal can affect the autonomic nerve
supply to the bladder and bowel, leading to dysfunction. Bladder: either
decreased activity with difficulty passing urine and inability to
completely empty the bladder, or increased activity resulting in urgency
Bowel: the usual effect is
constipation; incontinence can also occur.
Does arachnoiditis cause
cancer in the spinal column?
Arachnoiditis is not known
to be a cause of cancer in the spinal column.
Can arachnoiditis cause
ringing in the ear?
Arachnoiditis is reported
in the Merck Manual as being a cause of Tinnitus. For further
information on Tinnitus and arachnoiditis as one of its causes, please
consult the Merck