Prescribing for common complications of spinal cord injury

Abstract

Objective To describe prescribing patterns for 3 common complications associated with spinal cord injury (SCI) and to provide family doctors with strategies for optimizing the care of patients with SCI. Sources of informationResults of a nationwide survey of prescription medication use among people with SCI in Canada and a longitudinal study of secondary complications associated with SCI.Main message Altered neurologic and cardiometabolic function in patients with SCI make it difficult for family physicians to predict optimal medication regimens for these patients. Three common problems seen in primary care among patients with SCI that require pharmacologic treatment are pain (treated in 57% of survey respondents), muscle spasms (54%), and recurrent urinary tract infections (43%). Pain management may require multiple medications, depending on the source or nature of the pain. Some prescription medications recommended for treating pain may be underused in this population, such as amitriptyline, while others may be overused in this population, such as antibiotics for urinary tract infections. Spasticity is often related to an underlying problem such as pain, and treatment of concomitant conditions may also reduce spasticity. Short-acting benzodiazepines were found to have been prescribed for spasticity outside the recommended treatment paradigm at a surprisingly high rate. The longitudinal study of secondary complications associated with SCI led to the development of Actionable Nuggets, an innovative knowledge translation tool for primary care providers. ConclusionTo provide optimal treatment to patients with SCI, family doctors are encouraged to engage in open communication with them about prescription medications, including aspects of cost, polypharmacy, and therapeutic substitutions. Family physicians should also explore interprofessional collaboration with SCI specialists and allied health providers to provide patients with nonpharmacologic strategies tailored to their activity levels and nutritional needs. The Actionable Nuggets mobile app provides family doctors with brief, actionable, evidence-based information on the top 20 health concerns associated with SCI.

Relationship between secondary health conditions and life satisfaction in persons with spinal cord injury: study across twenty-one countries

“…Due to high prevalence of SHCs and their relation to LS following SCI, development of strategies for improved health promotion, supported self-management, surveillance, and early intervention are of great importance. Our findings support the outcomes of previous research where preventive measures of primary care following SCI include regular follow-up by specialized teams and annual comprehensive health examination, as well as access to disability-specific expertise in the form of specialists, regarding common SHCs, such as pain and bowel and bladder complications [15]. Apart from that, there are at least several other options for increasing knowledge about own health status among persons with SCI, such as multimedia patient education resources (labeled SCI-U), developed by rehabilitation professionals and consumers from Canada available in the form of 'SCI and you' courses [32].…”

“…This is common in low-, middle-, and high-income countries, where persons in lowerincome groups are disproportionately affected. Specifically persons with SCI commonly have substantial unmet health needs when presenting for follow-up services and primary care, once initial rehabilitation has been completed [15][16][17]. A recent study reported that performance indicators for the health system were related to QoL, using data from the International Spinal Cord Injury (InSCI) community survey and furthermore, showed that the most important indicators for QoL were social attitudes and access to health care services [18].…”

Primary healthcare needs and service utilisation of people with disability: a data linkage protocol

“… 3 General practitioners (GPs) are important mainstream healthcare providers for the management, treatment and prevention of health complications. 4 As GPs are often the first point of contact with the healthcare system, they play a critical role in connecting patients with a wider healthcare team and developing holistic treatment plans to manage ongoing health conditions. 5 High-quality care provided by GPs has the potential to avoid unnecessary hospitalisation 6 7 and improve the health 8 and well-being 9 of people with disability.…”

“…The experience of disability is diverse and affected by multiple socioenvironmental factors, including care provided by healthcare services 3. General practitioners (GPs) are important mainstream healthcare providers for the management, treatment and prevention of health complications 4. As GPs are often the first point of contact with the healthcare system, they play a critical role in connecting patients with a wider healthcare team and developing holistic treatment plans to manage ongoing health conditions 5.…”

Health care crisis in Canada

“…This month's clinical review, for example, gives an overview of the pharmacologic management of patients with spinal cord injuries (page 885). 6 As the article states, we may each have only one patient in our practice with this condition, but we need to know how to help them. It is this very breadth of work that may have attracted many of us to general practice in the first place.…”