Prescribing patterns for treating common complications of spinal cord injury

Shikha Gupta; Mary Ann McColl; Karen Smith; Alexander McColl

doi:10.1080/10790268.2021.1920786

Prescribing patterns for treating common complications of spinal cord injury

J Spinal Cord Med. 2023 Mar;46(2):237-245. doi: 10.1080/10790268.2021.1920786. Epub 2021 May 6.

Authors

Shikha Gupta¹, Mary Ann McColl¹, Karen Smith², Alexander McColl³

Affiliations

¹ School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
² Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, Canada.
³ Rural Clinical School in Family Medicine, University of New South Wales, Sydney, Australia.

Abstract

Objective: The purpose of this study was to find the most and least commonly prescribed medications for treating secondary health complications associated with spinal cord injury (SCI); and determine overall polypharmacy rates and risk factors associated with it.

Design: Observational design, cross-sectional analysis.

Setting: Community; Canada.

Participants: Individuals with spinal cord injury (n = 108).

Results: A total of 515 prescriptions were issued to the sample comprising 213 different medications to treat 10 SCI-related complications. Forty-five (45%) participants were prescribed >5 medications concurrently. No associations were found between the number of drugs taken and age, sex, level of injury, completeness of injury, time since injury, or cause of injury. The most commonly treated complications included pain (56.5%), muscle spasms (54%) and urinary tract infections (43%). Anti-convulsants (pregabalin, gabapentin), anti-spasmodics (baclofen, diazepam) and nitrofurantoins (Macrobid) were the most commonly prescribed medications to treat each of the three conditions, respectively. Thirty five percent of the total sample received a combination of two or more analgesics including fourth-line agents in the opiate class (hydromorphone, hydrocodone and morphine). Similarly, some participants were prescribed general muscle relaxants and cephalosporins for treatment of muscle spasms and urinary tract infections, respectively, that are generally not recommended in SCI patients. We compare these prescribing patterns with the available clinical practice guidelines and highlight areas where the prescriptions fall outside the recommended clinical practice while considering the complexity of medication management in SCI.

Conclusion: Medication management in SCI is complex. Tools are required that enable prescribers to choose evidence-based medical regimens and deprescribe potentially inappropriate medications for their patients with SCI.

Keywords: Medication management; Polypharmacy; Prescription patterns; Secondary health conditions; Spinal cord injury.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Analgesics / therapeutic use
Cross-Sectional Studies
Humans
Pregabalin / therapeutic use
Spasm / complications
Spasm / drug therapy
Spinal Cord Injuries* / complications
Spinal Cord Injuries* / drug therapy

Substances

Analgesics
Pregabalin

Grants and funding

This research was conducted as part of the doctoral thesis work of Shikha Gupta. Her work was supported through doctoral studentship and Mark S lodge Fund awarded by Queen's University.