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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.
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Since most cases of arachnoiditis and the so called failed back surgery syndrome are caused during a diagnostic or therapeutic intervention of the spine, there is a certain reticence to admit that, in most instances, it is a disease related to interventionism gone astray.77 It raises the question as to whether diagnostic (myelograms, spinal taps, discograms, etc.) or therapeutic invasions of the spine (laminectomies, fusions, epidural or spinal anesthesia, neuroplasties, epidural injections of steroids, etc.) need to be limited to specific indications.

The majority of patients in this series were not working, required assisted care, made frequent doctor visits, underwent repeated procedures that only produced temporary pain relief and, even though most of them were taking a myriad of medications, including opiates, they continued to experience severe pain. Considering that the severity and chronicity of such morbidity includes life-term suffering, psychological dysfunction, and physical disability—resulting in an enormous cost to the health care system—prevention in this case, by far outweighs the effectiveness of any therapeutic modality attempted.

In caring for these patients, one cannot help but to emphasize that it is primordial to make thoughtful and objective decisions regarding interventional diagnostic or therapeutic modalities of the spine, given the potential for an adverse long-term outcome. Since, at present, there is no definitive cure for this condition, emphasis needs to be placed on prevention. Invasive interventions in the spine should only be performed when absolutely necessary and only when such procedures have been shown to offer a definite benefit to the patient.

Acknowledgments

The author wishes to acknowledge the valuable assistance of Rhamsis F. Ghaly, MD; Thomas L. Brown, MD; John Brannan, MD; Luis A. Vascello, MD; Juan Zapata, MD; Brent Decker, PhD; Valentina T. Aldrete, DDS, MHSA, JD; Sonya Johnson, RN; Frederika Montpetit, PL; Kay Williams, RN; Lou Decker, PRT; and Olga Suarez, MD in caring for these patients and gathering the data presented in this article.

Last updated on: April 13, 2017
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