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10 Articles in Volume 6, Issue #1
Bioethics
Do Topical Herbal Agents Provide Pain Relief?
Infusion Catheter Epidural
New Report of a High-Dose Morphine Metabolite
Pain Education and Pain Educators
Suspecting and Diagnosing Arachnoiditis
Tennant Blood Study — First Update
The Demise of Multidisciplinary Pain Management Clinics?
The Dimensions of Pain
The Role of Psychology in Pain Management

Suspecting and Diagnosing Arachnoiditis

A review of the symptoms noted in a group of patients with arachnoiditis presents an analysis of clinical observations of this disease.
Page 4 of 8
Table 4. Symptoms Related To Bladder Dysfunction In Patients With Arachnoiditis
Symptom Female Male
Dysuria 149 (58.2%) 168 (72.1%)
Hesitation 78 (30.4%) 112 (48%)
Incomplete emptying of bladder 197 (76.9%) 143 (61.3%)
Frequency 225 (87.8%) 136 (58.3%)
Urgency 189 (73.8%) 81 (34.7%)
Incontinence 221* (86.3%) 48 (20.6%)
Needed self- catetherization 61 (23.8%) 9 (3.8%)
*73 of them (28.5%) also had recognized pelvic floor weakness

Sexual Dysfunction

Only six women (2.3 %) claimed no sexual dysfunction. One hundred and eighteen (46%) had pain at penetration. Two hundred and thirteen (83.2 %) noted loss of libido since the onset of their back pain. Lower back pain during intercourse was reported by 217 (84.6%) women, while 34 of them (13.2%) had pain in their lower extremities as well. 81 patients (31.6%) had exacerbation of their back pain after intercourse. When asked if any particular position for intercourse was better tolerated, 75 patients (29.2%) felt that the sitting on top position was better tolerated, whereas 56 patients (21.8%) preferred the supine position, 57 others (22.2%) were more comfortable on the lateral decubitus with the variant labeled as the “spoon" position, and 3 others (1.1%) felt it was less uncomfortable when sitting on a bench or sofa.

Symptoms and incidence of sexual dysfunction in the male patients are presented in Table 5. It is evident that impotence was the most common dysfunction; however no adjustments were made for the usual sexual dysfunction that may be present in a normally-aging population. The group of patients (233) is considered too small to conclude any significant result, especially since there was such a wide range of ages.

Table 5. Manifestations of Sexual Dysfunction In Male Patients With Arachnoiditis
Reduced libido 198 (84.9%)
Partial and short lasting erection 96 (41.2%)
Complete impotence 113 (48.9%)
Perineal pain during erection 29 (12.4%)
Perineal burning during erection 16 6.8%)
Low back pain during intercourse 135 (57.9%)
Lower extremity pain during intercourse 8 (3.4%)
Low back pain after intercourse 154 (66%)
Received counseling 29 (12.4%)
Unsuccessful counseling 21 (72.4%)

There is no doubt that chronic back pain affects sexual activity. Although many of the patients in this series had low back pain before the apparent onset of arachnoiditis, no effort was made to differentiate it from the effect of chronic back pain, alone, on sexual performance. However, it was evident that sphincter and perineal muscle-related manifestations were more apparent after the symptoms of ARC became evident. While most of these symptoms were enough to have affected their sexual performance, it was impossible to discern what additional impact anxiety and fear of pain might have had on arousal and performance during intercourse. It was also not determined how sexual dysfunction was affected by pain during coitus and how it may have affected these patients’ sex lives. While the sexual component has been generally ignored in the past, the impact on adult patients’ quality of life and interrelationships requires that it be recognized and addressed. Physicians that care for this patient population need to regularly document the type of symptoms and psychological responses as they relate to sexual function.

Other Activities

Before the appearance of symptoms attributed to ARC, 87 of the male patients (37.3%) played some sport or performed regular physical exercise. Similarly, 112 (43.7% ) women played some sport regularly. In all cases, regular physical exercise was interrupted after the injurious event. All patients reported that they had to abandon most outdoor leisure activities because exerting themselves usually exacerbated the intensity of the pain.

Habits and Circumstances

Certain habits and social conditions were present with sufficient regularity to establish a pattern which merits notice. For example, 469 patients (95.9%) complained of insomnia while 361 patients (73.8%) required hypnotics for treatment. Dreams were reported in only 132 patients (26.9%). In addition, 336 patients (68.7%), of which 182 were males and 125 females, smoked cigarettes, but only 18 patients (3.6%) admitted to drinking alcoholic beverages in excess. Total disability had been granted to 394 (80.5%) while 19 patients (3.8) were partially disabled. Only 29 of them (5.9%) worked full time and an undetermined number of them had some part time work. When first seen, 112 patients (22.9%) were involved in litigation and 22 others (4.4%) had settled previous claims.

Radiological Diagnosis

In every case, the clinical diagnosis was confirmed by diagnostic imaging studies including either magnetic resonance (MRI) or a myelogram followed by a computerized axial tomography (CAT) scan, when the former was contraindicated. It is suggested that if one or more of the following lesions is present in a patient, then a diagnosis of arachnoiditis is confirmed.

Last updated on: April 13, 2017
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