Prescribing for common complications of spinal cord injury

Canadian Family Physician, 2022 · DOI: 10.46747/cfp.6812885 · Published: December 1, 2022

Spinal Cord Injury Pharmacology Healthcare

Simple Explanation

Family physicians may find it challenging to provide the best evidence-based care for patients with spinal cord injury (SCI), especially when prescribing medications for SCI-specific clinical problems. Three common complications of SCI that often require medication are pain, muscle spasms, and recurrent urinary tract infections (UTIs). Effective management involves open communication between doctors and patients, collaboration with specialists, and utilizing resources like the Actionable Nuggets mobile app for guidance.

Study Duration

Not specified

Participants

108 survey participants with SCI

Evidence Level

Clinical Review

Key Findings

1
Neuropathic pain is highly prevalent in SCI patients, affecting approximately 75% of patients.
2
Short-acting benzodiazepines were surprisingly commonly prescribed for spasticity, despite not being part of the recommended treatment paradigm.
3
There is a tendency to overtreat UTIs in SCI patients, contributing to antibiotic resistance.

Research Summary

This clinical review focuses on prescribing patterns for three common complications of spinal cord injury (SCI): pain, muscle spasms, and recurrent urinary tract infections (UTIs). The review highlights the challenges family physicians face in managing these conditions due to altered neurologic and cardiometabolic function in SCI patients. It emphasizes the importance of individualized treatment plans, interprofessional collaboration, and the use of resources like the Actionable Nuggets app to optimize care for patients with SCI.

Practical Implications

Individualized Pain Management

Tailor pain medication regimens to the specific source and nature of the patient's pain, considering multiple medications if necessary.

Cautious UTI Treatment

Avoid overtreating UTIs in SCI patients to prevent antibiotic resistance, and reserve antibiotics for symptomatic infections with substantial bacteriuria and pyuria.

Comprehensive Spasticity Management

Address underlying causes of spasticity, such as pain or UTIs, and consider non-pharmacologic strategies alongside medication.

Study Limitations

1
The findings are based on a survey and longitudinal study conducted by the authors, which may have limitations in generalizability.
2
The review focuses on pharmacologic management and might not fully cover all non-pharmacologic approaches.
3
The rapid evolution of evidence in this area necessitates continuous updating of knowledge and practices.

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