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Understanding Arachnoiditis: Causes, Symptoms, and Treatment Options

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on February 17th, 2024.

Key Takeaways

  • Inflammation occurs in the arachnoid membrane—the middle layer of three protective coverings around the spinal cord and brain—causing nerve roots to stick together and form painful scar tissue.

  • Most cases develop following spinal surgery complications (especially multiple procedures), contrast dye reactions during myelograms, or severe infections like bacterial meningitis that breach spinal barriers.

  • Characteristic pain presents as constant burning, stinging, or electric-shock sensations in the lower back radiating down both legs, often described as feeling like "hot oil" poured on the spine.

  • Unlike other back conditions, symptoms typically worsen over time and don't respond well to standard treatments—patients often experience progressive muscle weakness and bowel/bladder dysfunction.

  • Pain management focuses on neuropathic medications like gabapentin (300-1800mg daily) or pregabalin, combined with low-impact exercise and psychological support, since anti-inflammatory drugs provide limited relief.

Arachnoiditis is a painful disorder that occurs when the arachnoid, one of the protective membranes surrounding the brain and spinal cord, becomes inflamed. This inflammation can lead to severe burning or stinging pain and various neurological problems, significantly impacting a person's quality of life.

What Causes Arachnoiditis?

Several factors can trigger inflammation of the arachnoid membrane, including:

  • Spinal cord injury, often related to complications from spinal surgery or procedures such as epidural injections and spinal taps

  • Infections caused by viruses or bacteria, such as bacterial meningitis of the spine

  • Compression of the spinal nerves due to chronic degenerative disc disease or advanced spinal stenosis (narrowing of the spinal column)

Symptoms of Arachnoiditis

The most common symptom of arachnoiditis is severe burning or stinging pain in the lower back or legs. Other symptoms may include:

  • Weakness, numbness, or tingling in the legs

  • Pins and needles sensation (paresthesia)

  • Joint pain

  • Ringing in the ears (tinnitus)

  • Fatigue

  • Bowel and bladder problems

  • Sexual dysfunction

As the condition progresses, symptoms may worsen and become permanent, leading to significant disability and inability to work due to constant pain.

Diagnosing Arachnoiditis

Diagnosing arachnoiditis can be challenging, but imaging tests such as CT scans (computerized tomography) and MRIs (magnetic resonance imaging) have improved the process. An electromyogram (EMG) can also be used to assess the severity of ongoing damage to affected nerve roots by using electrical impulses to check nerve function.

Treatment Options for Arachnoiditis

Currently, there is no cure for arachnoiditis. Treatment focuses on managing pain and improving symptoms that affect daily life. Common approaches include:

  • Pain management programs

  • Physical therapy

  • Exercise

  • Psychotherapy

Surgery for arachnoiditis is controversial and often provides only short-term relief with potentially poor outcomes. More research is needed to determine the effectiveness of treatments such as steroid injections and electrical stimulation.

Coping with Arachnoiditis

Living with arachnoiditis can be challenging, but working closely with healthcare professionals and exploring various treatment options can help manage symptoms and improve quality of life. It is essential for those affected by this condition to have a strong support system and to prioritize self-care and stress management techniques.

The Bottom Line

This irreversible condition requires early, aggressive pain management to prevent progressive disability and maintain function. The key is working with specialists experienced in neuropathic pain rather than pursuing repeated procedures that could worsen inflammation. If you're experiencing persistent burning back pain that radiates down both legs, especially after spinal procedures, Doctronic can help connect you with appropriate specialists quickly.

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