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reported to occur in approximately 0.05% of Myodil cases which is contrast agent are often enmeshed in the dense scar tissue. The why it is recommended that the agent be removed from the spinal entangled nerve roots hypovasculate and become progressively column after examination." Such removal was never done in atrophic." Australia. Lumbosacral adhesive arachnoiditis is a particularly cruel disease The Australian Adverse Drug Reactions Bulletin noted the because of the nature of the pain syndrome associated with it, yet its relationship between the retention of Myodil and adhesive pathophysiology is well understood and is no mystery. The type of arachnoiditis as far back as February 1975. pain is uniquely incapacitating, and dolorologists have created the Arachnoidal reaction in the brain is most prominent around the term "regional complex pain disorder" (RCPD) to describe it. brain stem, which is significant due to the close proximity to the (Source: Derek Morrison) lower cranial nerves. As explained by Dr I. H. J. Bourne (now This writer has seen X-ray evidence and a report dated 7 deceased) in "Lumbo-Sacral Adhesive Arachnoiditis: A Review", September 1982 (by D. Jones, radiologist at Murwillumbah (Journal of the Royal Society of Medicine 1990; 83: 262-265, Hospital, NSW) of Myodil widely dispersed in spinal canals and in 1990): "the basal cisterns of the skull", as well as MRI evidence dated 28 "The relentless and progressive pain syndrome of arachnoiditis is March 2006 (from Dr G. Ioannou of South Coast Radiology) of taxing to the patient's morale. In many instances doctors, relatives Myodil reaching the brain, "located in the left middle cranial fossa". and friends fail to realise that the pain can be as bad as terminal cancer, without the prospect Adverse reaction rates of death to end the suffering. Well-meaning In June 1998, the US National Institutes of enquiries as to whether there is any Health published "new" findings in relation to improvement, with the implication that there the "cause and effect" of iophendylate, listing must inevitably be improvement 'since it is not 80 medical conditions based on reported cancer’, are distressing to the patient. There adverse reactions, many of which can be are sympathetic doctors, relatives and friends considered life threatening. Commenting on no expect hs paves shes | Adhesive atachnoiditis | tisSK axis grup nod, enat less exhortation and more compassion. is nota notifiable record of such ‘official, reported’ related Compassion is an important consequence of disease in most medical conditions is available to yourself and comprehension of the existence and nature of the wider community, especially sufferers and arachnoiditis." countries and, as such, their loved ones." i i i It's important to place it on the record Arachnoiditis pathophysiology there is no obligation that until now the medical profession According to Jennifer Owen in her on the doctors to throughout the world has stated that thesis for her Master of Science (Optomology) (University of NSW, June 1998): "Cranial palsies and late visual effects may arise independently or follow the acute reaction. The contrast agent injected into the lower spine reaches the cranium, as Myodil has been noted on the dental X-rays of patients with chronic headaches and jaw pain. Even after removal of the dye, there is always This figure is sourced from the US Food a small amount of residual dye that can and Drug Administration, the body that reach the brain. originally licensed iophendylate (as Pantopaque). "Immediate reactions, which are either allergic or vascular, The FDA's Spontaneous Reporting System, maintained by the include allergic reactions of the conjunctiva and lids, flickering light Division of Epidemiology and Surveillance, noted on 12 June 1998 and photophobia. Late effects that involve the posterior visual that between 1991 and 1995 in the USA, 335 adverse reactions were pathways include reduced vision, red-green colour defects, scotomas reported with this chemical. Of these 335 people with adverse chemically induced adhesive arachnoiditis develops in "less than 1% of patients" who have previously undergone a myelography with iophendylate. Furthermore, "it's a very rare phenomena [sic]". This statement is not only misleading, it's a lie. In fact, the most current statistical data published shows that the figure is 82.3 per cent. report cases. and cortical blindness. reactions, 275 developed chemically induced adhesive "Arachnoiditis is characterised by the formation of granulomatous _arachnoiditis—a reported 82.3% relationship (actually, 82.19%), not tissue and nerve root adhesions within the leptomeningeal sac. the "less than 1% of patients" as currently being touted in the courts Since the arachnoid and subarachnoid spaces are void of blood by medical bodies. vessels, it is expected that the inflammatory reaction arises in the UK medical researcher S. P. Cunliffe, writing to doctors in 1997, enriched cascularised pia and dura mater. The pia mater is easily asked: "So why have doctors to date said that adhesive arachnoiditis traumatised as it is very fragile and sensitive to both chemical and is arare condition? The answer to that is very simple. Adhesive physical injury, and the dura can participate in the production of arachnoiditis is not a notifiable disease in most countries and, as both dura-leptomeningeal adhesions even without its own direct such, there is no obligation on the doctors to report cases or collect injury. any data recording the number of sufferers. Nor are they reporting "Upon application of a contrast agent, the delicate structure of the adhesive arachnoiditis as a side effect of any drugs used." arachnoid tissue is invaded by macrophages and covered with a Commenting on the situation in Australia, Cunliffe said: "It's time fibrin-like substance. The ensuing inflammation adheres the pia to the Australian Government instructed doctors who see and treat the dura, obliterating the subarachnoid space. Globules of the those suffering this disease to report these adverse reactions; countries and, as such, there is no obligation on the doctors to report cases. 36 = NEXUS Adhesive arachnoiditis is not a notifiable disease in most www.nexusmagazine.com AUGUST — SEPTEMBER 2006