Anticipate these 3 common complications of spinal cord injuries that present to your office:
1. Neuropathic Pain
First line agents for neuropathic pain are pregabalin, gabapentin and amitriptyline. Caution with the TCAs because of anti-cholinergic side effects at analgesic does. Second line agents with the most evidence are tramadol and lamotrigine. Opioids can be considered with caution. There is NO evidence for clonidine, mexiletine, levetiracetam, valproic acid, trazodone, duloxetine.
2. Muscle Spasms
Individuals with upper thoracic lesions (above T5) can have significant functionally limiting spasticity. Oral or intrathecal baclofen is used first line. Other antispasmodic agents can be considered second line including cannabis, clonidine and cyproheptadine. Avoid benzodiazepines where possible.
3. Recurrent Urinary Tract Infections (> 3/year) from Neurogenic Bladder
UTIs are often over-treated leading to increased polymicrobial infections and antibiotic resistance in this group. Reserve antibiotics for individual who are symptomatic WITH substantial bacteriuria AND pyuria (>50 WBCs / hpf), and do NOT offer routine prophylactic antibiotics. First line agents remain nitrofurantoins and cephalosporins, although there is no formal guidance for SCI.
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