Drugs and Medications for Spinal Cord Injury

Spinal cord injury (SCI) treatment is complex. Besides the primary injury, a cascade of secondary conditions may develop immediately after the injury or later. Drugs and medications may be used for the primary injury and / or to treat the secondary conditions.

First Response after SCI
Preventing and controlling inflammation is a first response following SCI. A drug called methylprednisolone may be administered immediately and continued for 24 to 48 hours. It is a man-made synthetic corticosteroid drug. Corticosteroids are powerful anti-inflammatory drugs.

Secondary Conditions
There are many secondary conditions that can develop after a spinal cord injury. Besides the conditions outlined below, other challenges include bladder and bowel management, dealing with fatigue, skin problems, and nutrition.

• Autonomic Dysreflexia (AD) is a serious and potentially life-threatening emergency associated with SCI. AD causes over-activity of the autonomic nervous system. In other words, communication between the body and brain is disrupted above the injury level. This means body functions, such as breathing, blood pressure, and heart rate become unregulated. Drugs that decrease heart rate and relax blood vessels include nitroglycerine and clonidine (Catapres) (1). They can be used to treat AD.
  
  
• Respiratory infections may develop when chest and abdominal muscles are weak, such as in cervical and thoracic SCI. Difficulty or inability to cough contributes to the development of respiratory infection. Common infections include the common cold, bronchitis, and pneumonia. Antibiotics may be prescribed to clear the chest.
  
  
• Spasticity is characterized by stiff or rigid muscles that make movement, such as walking or talking, difficult. Muscle relaxant and anti-spastic drugs such as baclofen (Lioresal), cyclobenzaprine, and Botox may be helpful.
  
  
• Pain caused by the injury, even in areas where there is no sensation or feeling is limited, is common. SCI patients who use wheelchairs may develop shoulder or arm pain (e.g., tendonitis). Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), muscle relaxants, anti-depressants, and painkillers (e.g., narcotics).
  
  
• Chronic pain (e.g., neurogenic, nerve pain) often accompanies paralysis. Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), gabapentin (Neurontin, an anti-seizure drug), muscle relaxants, anti-depressants, and painkillers (e.g., narcotics).
  
  
• Depression is common, but there are many medications that are used to treat this disorder. Sometimes, anti-depressant medications are combined. Some examples of anti-depressant medications are:
  • Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac
  • Tricylic drugs (e.g., Elavil)
  • Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs), such as Cymbalta (duloxetine). Cymbalta also treats anxiety.

   

Reference

1. Maddox, S. Paralysis Resource Guide, Christopher Reeve Paralysis Foundation, Springfield, NJ. 2003. Page 58.