Prescribing for common complications of spinal cord injury

[摘要] Objective To describe prescribing patterns for 3 common complicationsassociated with spinal cord injury (SCI) and to provide family doctors withstrategies for optimizing the care of patients with SCI.Sources of information Results of a nationwide survey of prescriptionmedication use among people with SCI in Canada and a longitudinal study ofsecondary complications associated with SCI.Main message Altered neurologic and cardiometabolic function in patientswith SCI make it difficult for family physicians to predict optimal medicationregimens for these patients. Three common problems seen in primarycare among patients with SCI that require pharmacologic treatment arepain (treated in 57% of survey respondents), muscle spasms (54%), andrecurrent urinary tract infections (43%). Pain management may requiremultiple medications, depending on the source or nature of the pain. Someprescription medications recommended for treating pain may be underusedin this population, such as amitriptyline, while others may be overused inthis population, such as antibiotics for urinary tract infections. Spasticityis often related to an underlying problem such as pain, and treatmentof concomitant conditions may also reduce spasticity. Short-actingbenzodiazepines were found to have been prescribed for spasticity outsidethe recommended treatment paradigm at a surprisingly high rate. Thelongitudinal study of secondary complications associated with SCI led tothe development of Actionable Nuggets, an innovative knowledgetranslation tool for primary care providers.Conclusion To provide optimal treatment to patients with SCI, familydoctors are encouraged to engage in open communication with themabout prescription medications, including aspects of cost, polypharmacy,and therapeutic substitutions. Family physicians should also exploreinterprofessional collaboration with SCI specialists and allied healthproviders to provide patients with nonpharmacologic strategies tailored totheir activity levels and nutritional needs. The Actionable Nuggets mobileapp provides family doctors with brief, actionable, evidence-based informationon the top 20 health concerns associated with SCI.

[学科分类] 卫生学