Paraplegia involves the loss of motor and sensory function in the lower half of the body from a spinal cord injury. While no medication can reverse the paralysis, various drugs are used to manage symptoms and prevent secondary health complications. The goal of this pharmacological treatment is to alleviate discomfort, allowing individuals to engage more fully in rehabilitation and daily life.
Medications for Neuropathic Pain
Following a spinal cord injury, many individuals experience neuropathic pain, which originates from damaged nerves sending incorrect signals. This pain is often described as burning, tingling, or shooting sensations and does not respond well to common analgesics. Its management requires medications that alter nerve activity.
The primary medications for neuropathic pain were originally developed for other conditions. Anticonvulsants, such as gabapentin and pregabalin, are first-line treatments. These drugs work by reducing the release of pain-transmitting neurotransmitters, which calms the overactive nerve signals.
Certain antidepressants, particularly tricyclic antidepressants like amitriptyline, are also effective. These drugs increase the levels of neurotransmitters such as serotonin and norepinephrine in the brain and spinal cord. This helps modulate and dampen the persistent pain signals common to neuropathic conditions.
Controlling Muscle Spasticity
Muscle spasticity is a common consequence of paraplegia, characterized by involuntary muscle stiffness and spasms. This occurs because the spinal cord injury disrupts signals between the brain and the muscles, leading to uncontrolled reflexes. Managing spasticity is important for comfort, mobility, and preventing joint contractures.
Oral medications are the first approach for managing widespread spasticity. Baclofen is a muscle relaxant that acts on the central nervous system to reduce the frequency and severity of muscle spasms. Another common medication is tizanidine, which works centrally to block nerve impulses that cause muscle tightness.
For spasticity localized to specific muscle groups, injections of botulinum toxin (Botox) are an effective treatment. It works by blocking the release of acetylcholine, a chemical that signals muscles to contract, relaxing the targeted muscles for several months. In cases of severe spasticity that doesn’t respond to oral drugs, an intrathecal baclofen pump may be surgically implanted. This device delivers baclofen directly into the spinal fluid, allowing a lower dose to be used while minimizing side effects.
Addressing Bladder and Bowel Dysfunction
Nerve damage from a spinal cord injury disrupts control over bladder and bowel functions, a condition known as neurogenic bladder and bowel. For the bladder, anticholinergic medications like oxybutynin are used to relax the bladder muscle. This increases the bladder’s capacity to hold urine and reduces incontinence caused by muscle spasms.
Managing the neurogenic bowel involves establishing a regular routine supported by medication. Stool softeners and laxatives like senna or polyethylene glycol are used to ensure stool consistency and prevent constipation. Rectal suppositories or mini-enemas may also be used to stimulate a bowel movement at a scheduled time.
Managing Secondary Health Risks
Reduced mobility from paraplegia increases the risk of secondary health conditions like deep vein thrombosis (DVT), which are blood clots in the veins. To counter this, physicians prescribe anticoagulant medications, or blood thinners, to prevent clots from forming.
Individuals with paraplegia are also more susceptible to infections. Urinary tract infections (UTIs) can become recurrent due to catheter use and changes in bladder function. Antibiotics are the primary treatment for UTIs and for skin infections that can result from pressure sores.
The absence of weight-bearing activities can lead to a loss of bone density, a condition known as osteoporosis, making bones more fragile. To maintain bone health, doctors may prescribe medications that slow bone loss. Supplements such as calcium and vitamin D are also recommended.