Chronic pain syndromes are rare conditions but an important aspect surrounding these issues is determining the origin of the pain so that the symptoms and cause of the conditions can be managed effectively enough. Chronic pain affects people’s normal daily activities, work duties, and can have a profound negative impact on one’s emotional status.
Two important causes of chronic pain are fibromyalgia and arachnoiditis. They are two distinctly different conditions as their mechanisms of onset and causes differ although the symptoms experienced by patients mimic each other, especially the chronic pain they cause.
Fibromyalgia is a condition that results in chronic pain in the muscles and joints of the body. It is characterized by symmetrical involvement of anatomical areas which involve both sides as well as above and below the midline of the body.
Symptoms and signs of fibromyalgia include:
· Chronic fatigue
· The mentioned chronic pain in the muscles or muscle groups and joints.
· Muscle and/or joint stiffness.
· Difficulty with concentrating.
· Migraine headaches.
· Depressed mood as an effect of chronic pain.
There is no cure for fibromyalgia so the management of the condition focuses on controlling the symptoms experienced by the affected individual. This can be achieved through pain medications, intramuscular or trigger point injections, and even regenerative medicine in the form of stem cell therapy. The latter works by stem cells either converting into muscle cells to take the place of damaged cells due to inflammation or by stimulating the release of anti-inflammatory factors in the bloodstream to reduce inflammation associated with the condition.
Arachnoiditis is less common than fibromyalgia and is a condition associated with inflammation of the arachnoid membrane, which is one of the tissues that cover the brain, spinal cord, and nerves of the central nervous system. This condition can become extremely debilitating to affected patients even causing severe disability, especially when the inflammation around the affected area of the membrane results in scar tissue forming which leads to adhesions developing causing the nerves to stick together (adhesive arachnoiditis). This can further become complicated where the adhesions become hard and calcify causing a condition known as arachnoiditis ossificans.
Symptoms and signs of arachnoiditis include:
· Stinging or burning nerve pain in the areas below the level of the pathology in the spine.
· A tingling or numb sensation involving the legs.
· Muscle cramps.
· Autonomic nerve dysfunction which can lead to bladder and/or bowel incontinence and sexual dysfunction.
Arachnoiditis can be caused by trauma to or infections of the arachnoid membrane, but one of the most associated situations includes inflammation caused by accidentally injecting steroid medications or local anesthetic agents into the space between the arachnoid membrane and dura mater when performing epidural injections.
Just like fibromyalgia, there is no cure for arachnoiditis but the symptoms caused by the condition can be managed with pain medications, nerve blocking injections as one would want to avoid any further administration of epidural injections, and physical therapy.
Psychotherapy may be important for these patients as the pain can cause severe emotional disturbances which can lead to severe depression. The therapy will help patients to try feedback therapy where they learn to try and control the pain, but will also aid in keeping their emotions in check. Relaxation techniques and therapies will also help to try and reduce as much anxiety and stress as possible as these can feed pain and cause it to worsen.
Soma is a pill called a muscle relaxant. The main effect of these pills is to block nerve impulses that are sent to the brain. More information at https://thefitnessequation.com/tfestore/soma-carisoprodol/. Therefore, these tablets are used primarily in the treatment of muscle damage or wounds.
Platelet-rich plasma therapy (PRP), where the patient’s own blood is drawn, centrifuged, and the platelet-rich plasma is extracted and prepared, has been administered to patients in a study that looked at the possibility of this therapy as an alternative for epidural steroid administration in the management pain in patients with herniated intervertebral discs. The use of the PRP therapy is being considered for managing arachnoiditis but further research needs to be conducted on this possibility.
1. Idris Z, Ghazali FH, Abdullah JM. Fibromyalgia and arachnoiditis presented as an acute spinal disorder. Surgical Neurology International. 2014;5:151. doi:10.4103/2152-7806.143364.
2. Morisako H, Takami T, Yamagata T, Chokyu I, Tsuyuguchi N, Ohata K. Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution. Journal of Craniovertebral Junction and Spine. 2010;1(2):100-106. doi:10.4103/0974-8237.77673.
3. Bhatia R, Chopra G. Efficacy of Platelet Rich Plasma via Lumbar Epidural Route in Chronic Prolapsed Intervertebral Disc Patients-A Pilot Study. Journal of Clinical and Diagnostic Research : JCDR. 2016;10(9):UC05-UC07. doi:10.7860/JCDR/2016/21863.8482.
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