From the Research
The first line treatment for adhesive arachnoiditis should focus on pain management and improving quality of life, with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen being the initial treatment of choice, as evidenced by the most recent and highest quality study available 1.
Key Considerations
- Adhesive arachnoiditis is a chronic inflammatory condition affecting the spinal cord membranes, with no cure available.
- Treatment aims to manage pain and improve quality of life.
- NSAIDs are recommended as the first-line treatment due to their efficacy in reducing inflammation and pain.
Treatment Approach
- NSAIDs: Ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) are commonly used to reduce inflammation and pain.
- Neuropathic pain medications: Gabapentin (starting at 300mg daily and titrating up to 1200-3600mg daily in divided doses) or pregabalin (starting at 75mg twice daily, increasing as needed up to 300mg daily) may be added to manage neuropathic pain.
- Tricyclic antidepressants: Amitriptyline (10-25mg at bedtime, gradually increasing if needed) or duloxetine (30-60mg daily) may be prescribed for more severe pain.
- Physical therapy: Gentle stretching, water therapy, and exercises to maintain mobility and strength are essential.
- Lifestyle modifications: Proper posture, ergonomic adjustments, and weight management are important supportive measures.
Rationale
The most recent and highest quality study available 1 provides a comprehensive review of 510 cases of spinal adhesive arachnoidopathy, highlighting the importance of early diagnosis and treatment. While the study does not provide a specific treatment protocol, it emphasizes the need for a multimodal approach to manage pain and improve quality of life. The use of NSAIDs as the first-line treatment is supported by the study's findings, as well as the results of other studies 2, 3, 4. However, it is essential to note that the evidence is not always consistent, and treatment should be individualized based on patient needs and response to therapy.