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Pain and Spine Medicine

Arachnoiditis Responsive to Duloxetine: A Case Report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Alex Turner, MD

    Resident Physician
    University of Kentucky College of Medicine PM&R Program
    Lexington, Kentucky

    • Co-Author(s)

  • AK

    Augusta Kiepper, DO

    Resident Physician
    University of Kentucky College of Medicine PM&R Program
    Lexington, Kentucky

  • MC

    Morgan Cassidy, DO

    Resident
    University of Kentucky College of Medicine PM&R Program
    Lexington, Kentucky

  • DP

    Dwan Perry, DO

    Associate Professor, PM&R
    University of Kentucky College of Medicine
    Lexington, Kentucky

Disclosure(s):
Alex Turner, MD: No financial relationships to disclose
Case Diagnosis: Arachnoiditis of the lumbar spine

Case Description or Program Description: This patient presented to our outpatient clinic with the complaint of bilateral lower extremity pain and weakness that developed following bilateral partial knee replacements. At the initial clinic visit, she described bilateral lower extremity tingling and burning pain radiating from the posterior proximal thigh to the knee, which was provoked with standing and walking. Her symptoms were greater on the right than the left. Exam revealed tenderness of the piriformis and subsequently ultrasound guided piriformis corticosteroid injection was performed. She returned approximately three weeks later, with moderate improvement in her pain severity and ability to ambulate, however, the pain now extended to bilateral lower legs in the anterolateral aspects. Because of this, an MRI of the lumbar spine and EMG/NCS were ordered to evaluate for radiculopathy. She was also started on duloxetine for her neuropathic pain.

Setting: PM&R Outpatient Clinic

Assessment/Results: MRI showed severe degenerative changes in the lumbar spine and clumping of the nerve roots at L2-3, suggesting arachnoiditis. However, six weeks after starting duloxetine, the patient reported complete resolution of radicular pain at follow up. EMG/NCS showed no radiculopathy.

Discussion (relevance): This case highlights the diagnostic challenges of arachnoiditis, which presents with diverse symptoms. While there is no cure, symptom management with neuropathic pain agents like duloxetine can be effective.

Conclusions: Arachnoiditis is often mistaken for other conditions, and its diagnosis should be considered in patients with neuropathic pain. Symptom management with medications like duloxetine can be beneficial.