Arachnoiditis is a chronic neuropathic pain state assessed when a patient presents with neuropathic pain symptoms with accompanying “clumping” of nerves evidenced on radiographs. The reason arachnoiditis causes pain is not totally clear but current basic science research suggests that inflammatory cytokines contribute to the process. Thalidomide is an immunomodulator that alters the level of several cytokines believed to be involved in neuropathic pain. The following case report, approved by the Washington University in St. Louis Human Studies Committee, relays the experience of trialing thalidomide as a treatment of arachnoiditis.

Two individuals entered the study that fit our inclusionary and exclusionary criteria: documented arachnoiditis with symptoms present in the lower extremities without risk factors for intolerance to thalidomide. Part of the consent involved an adherence to the STEPS program. The following were assessed in these patients before, during and after treatment: VAS, CBC, metabolic panel, EKG, NCS, SF-36, concomitant medication, concurrent opioid use, Roland-Morris Low Back Pain Questionnaire.

The cohorts who entered the study gradually titrated thalidomide to a tolerable level: 150 mg in one and 200 mg in another. Both patients reported subjective improvement in the management of their pain though the study testing parameters did not reveal significant differences. Both patients stopped the therapy in time secondary to side effects.

Though thalidomide represents a novel means of treating arachnoiditis, our study cohort was limited in size and the individuals who did enter the study could not tolerate this medication for a sufficient period of time in order to fully assess its benefits.