scholarly journals A Primary Care Provider’s Guide to Pain After Spinal Cord Injury: Screening and Management

2020 ◽  
Vol 26 (3) ◽  
pp. 133-143
Author(s):  
Jithin Varghese ◽  
Kim D. Anderson ◽  
Eva Widerström-Noga ◽  
Upender Mehan
Keyword(s):  
Primary Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Treatment Options ◽  
Primary Care Providers ◽  
Assessment Tools ◽  
Treatment Modalities ◽  
Care Providers ◽  
Cord Injury

Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic. Various assessment tools are available to guide proper classification and subsequent management. Providers need to have a good knowledge base, structure, and patient focus when managing care. Nonpharmacological interventions are just as important and should be explored prior to or along with pharmacological interventions. Treatment modalities such as physical therapy, exercise, acupuncture, and cognitive behavioral therapy should be tailored to the individual to the greatest extent possible. Gabapentin, pregabalin, and amitriptyline have been studied extensively and are the first-line pharmacological agents for neuropathic pain. It is important to involve patients as equal stakeholders in any pain intervention with adequate lifelong follow-up. The aim of this article is to offer an overview of pain assessment, information, patient interaction, and treatment options available. Although chronic pain has remained difficult to treat successfully, primary care providers can play an integral role in delivering evidence-based and patient-centered care for managing chronic pain among individuals with SCI.

scholarly journals A Primary Care Provider’s Guide to Preventive Health After Spinal Cord Injury

2020 ◽  
Vol 26 (3) ◽  
pp. 209-219
Author(s):  
James Milligan ◽  
Stephen Burns ◽  
Suzanne Groah ◽  
Jeremy Howcroft
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Preventive Care ◽  
Primary Care Providers ◽  
Preventive Health ◽  
Care Providers ◽  
Health Maintenance ◽  
Cord Injury

Objective: Provide guidance for preventive health and health maintenance after spinal cord injury (SCI) for primary care providers (PCPs). Main message: Individuals with SCI may not receive the same preventive health care as the general population. Additionally, SCI-related secondary conditions may put their health at risk. SCI is considered a complex condition associated with many barriers to receiving quality primary care. Attention to routine preventive care and the unique health considerations of persons with SCI can improve health and quality of life and may prevent unnecessary health care utilization. Conclusion: PCPs are experts in preventive care and continuity of care, however individuals with SCI may not receive the same preventive care due to numerous barriers. This article serves as a quick reference for PCPs.

scholarly journals A Primary Care Provider’s Guide to Spasticity Management in Spinal Cord Injury

2020 ◽  
Vol 26 (3) ◽  
pp. 157-165
Author(s):  
Philippines Cabahug ◽  
Charles Pickard ◽  
Travis Edmiston ◽  
Jesse A. Lieberman
Keyword(s):  
Primary Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
General Practitioner ◽  
Primary Care Providers ◽  
Care Providers ◽  
Patient Centered ◽  
Muscle Spasticity ◽  
Comprehensive Management ◽  
Cord Injury

Background: Muscle spasticity is a common sequela of spinal cord injury (SCI) that may impact daily function. Spasticity dynamically varies and is an important physiologic response to illness or other stressors. The challenge for the general practitioner is in recognizing, treating, and developing an effective plan focused on the patient’s individual goals. Objective: To provide the general practitioner with a basic contextual, diagnostic, and therapeutic approach to spasticity management for individuals with neurologic injury such as SCI. Discussion: Muscle spasticity can be disabling and can be managed effectively by using a comprehensive approach. We discuss a representative case and the assessment and planning for individuals with SCI and spasticity. Through an understanding of pathophysiology, careful history taking, and physical exam, a cause for increased spasticity can be identified, such as infection, constipation, or pregnancy. Symptomatology of these triggers is often quite different in the SCI population than in the general population. Management includes the treatment of this causative stressor as well as the thoughtful management of spasticity itself. Conclusion: Muscle spasticity is dynamic and requires a patient-centered approach. The general practitioner can play a key role in recognizing and treating spasticity in an individual with SCI. Comprehensive management to meet patient and caregiver goals involves primary care providers, specialists, and allied health practitioners.

scholarly journals A Primary Care Provider’s Guide to Accessibility After Spinal Cord Injury

2020 ◽  
Vol 26 (2) ◽  
pp. 79-84
Author(s):  
Joseph Lee ◽  
Jithin Varghese ◽  
Rose Brooks ◽  
Benjamin J. Turpen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Care Services ◽  
Increased Risk ◽  
Cord Injury

Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual’s needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.

scholarly journals A Primary Care Provider’s Guide to Social Justice, the Right to Care, and the Barriers to Access After Spinal Cord Injury

2020 ◽  
Vol 26 (2) ◽  
pp. 85-90
Author(s):  
Angela Kuemmel ◽  
Josh Basile ◽  
Anne Bryden ◽  
Ngozi Ndukwe ◽  
Kelley Brooks Simoneaux
Keyword(s):  
Primary Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Social Justice ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Barriers To Access ◽  
Cord Injury ◽  
The Right

People living with spinal cord injury (SCI) face numerous barriers to primary care. This article identifies these barriers as social justice issues to emphasize their significance and the inequality of primary care received by people with SCI. Primary care providers have a responsibility to provide equal and accessible care to all patients and to remediate any obstacles to care. Understanding the well-documented barriers of competence, physical, policy and procedural, communication, and attitudes impacting primary care for people with SCI will bring much-needed awareness and opportunity for meaningful change. This article is a call to action for social justice within primary care and provides helpful recommendations for removing and addressing barriers. Better health care outcomes for people with SCI are possible if primary care physicians and providers become social justice advocates for their patients with SCI.

scholarly journals A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

2020 ◽  
Vol 26 (2) ◽  
pp. 108-115
Author(s):  
James Milligan ◽  
Lance L. Goetz ◽  
Michael J. Kennelly
Keyword(s):  
Primary Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Primary Care Providers ◽  
Lower Urinary Tract Dysfunction ◽  
Care Providers ◽  
Cord Injury ◽  
Lower Urinary

Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.

scholarly journals Pathophysiology of Neurogenic Obesity After Spinal Cord Injury

2021 ◽  
Vol 27 (1) ◽  
pp. 1-10 ◽  
Author(s):  
David R. Gater ◽  
Gary J. Farkas ◽  
Eduard Tiozzo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Primary Care Providers ◽  
Metabolic Dysfunction ◽  
Care Providers ◽  
Public Health Perspective ◽  
Sympathetic Dysfunction ◽  
The Metabolic Syndrome ◽  
Cord Injury ◽  
The Relationship

Individuals with a spinal cord injury (SCI) have a unique physiology characterized by sarcopenia, neurogenic osteoporosis, neurogenic anabolic deficiency, sympathetic dysfunction, and blunted satiety associated with their SCI, all of which alter energy balance and subsequently body composition. The distinct properties of “neurogenic obesity” place this population at great risk for metabolic dysfunction, including systemic inflammation, hyperglycemia, dyslipidemia, and hypertension. The purpose of this article is to demonstrate the relationship between neurogenic obesity and the metabolic syndrome after SCI, highlighting the mechanisms associated with adipose tissue pathology and those respective comorbidities. Additionally, representative studies of persons with SCI will be provided to elucidate the severity of the problem and to prompt greater vigilance among SCI specialists as well as primary care providers in order to better manage the epidemic from a public health perspective.

scholarly journals Pain Management in Spinal Cord Injury: A Narrative Review

2019 ◽  
Author(s):  
Zahid Hussain Khan ◽  
Hossein Majedi ◽  
Tahseen Asaad Hassan
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Pain Management ◽  
Treatment Options ◽  
Cauda Equina ◽  
Pharmacological Therapy ◽  
Cord Injury

Spinal cord injury (SCI) occurs due to any damage to the spinal cord and cauda equina. Most of the patients after spinal cord injury develop chronic pain, irrespective to the site and type of pain. This pain is severe in most of the cases and severely impairs the quality of life. The mechanisms responsible for the pain after spinal cord injury is poorly understood. The pain of SCI is basically classified in two main types: nociceptive or neuropathic. The objectives of this paper are to review the different treatment options for the SCI pain. The pain management after SCI includes pharmacological therapy and non-pharmacological therapy.

scholarly journals Potential for Cell-Transplant Therapy with Human Neuronal Precursors to Treat Neuropathic Pain in Models of PNS and CNS Injury: Comparison of hNT2.17 and hNT2.19 Cell Lines

2012 ◽  
Vol 2012 ◽  
pp. 1-31 ◽  
Author(s):  
Mary J. Eaton ◽  
Yerko Berrocal ◽  
Stacey Q. Wolfe
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cell Lines ◽  
Treatment Modalities ◽  
Cell Transplant ◽  
Cns Injury ◽  
Cord Injury ◽  
Neuronal Precursors

Effective treatment of sensory neuropathies in peripheral neuropathies and spinal cord injury (SCI) is one of the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord is a logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the potential of transplant of cells to treat chronic pain. Cell lines derived from the human neuronal NT2 cell line parentage, the hNT2.17 and hNT2.19 lines, which synthesize and release the neurotransmitters gamma-aminobutyric acid (GABA) and serotonin (5HT), respectively, have been used to evaluate the potential of cell-based release of antinociceptive agents near the lumbar dorsal (horn) spinal sensory cell centers to relieve neuropathic pain after PNS (partial nerve and diabetes-related injury) and CNS (spinal cord injury) damage in rat models. Both cell lines transplants potently and permanently reverse behavioral hypersensitivity without inducing tumors or other complications after grafting. Functioning as cellular minipumps for antinociception, human neuronal precursors, like these NT2-derived cell lines, would likely provide a useful adjuvant or replacement for current pharmacological treatments for neuropathic pain.

Qualitative Investigation of Health Information Resources for Caregivers and Individuals Living With Spinal Cord Injury

2021 ◽  
Author(s):  
Kacey Ferguson ◽  
Jessica Pope ◽  
Alaanah Bhanji ◽  
Sejean Yang ◽  
Lynn Gerber ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health Information ◽  
Primary Care Providers ◽  
The United States ◽  
The Internet ◽  
Care Providers ◽  
Basic Care ◽  
Cord Injury

Objectives: To identify the information networks of caregivers and individuals with spinal cord injury (SCI) and how the health information is accessed and used. Methods: For this qualitative study, participants from the United States were recruited through hospital listservs, websites, social media, and word of mouth to participate in a phone interview. Fourteen individuals living with a traumatic SCI and 18 caregivers of individuals living with a traumatic SCI were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim, coded using NVivo, and analyzed using qualitative thematic methods. Results: Participants reported that medical resources such as SCI specialists were considered the most reliable sources, but due to accessibility barriers the Internet was used the most. The Internet and social resources, such as online and in-person support groups, provided beneficial content information and emotional support, but they posed credibility concerns and left participants feeling unsure of reliability. Information gaps such as lack of education on basic care practices during the transition from acute to chronic care were identified by the participants. Conclusion: Because SCI is an overwhelming experience, it is difficult for patients to retain information in the initial acute care phase, leading to gaps in knowledge about long-term care. Patients are concerned about the reliability of online sources of information; therefore, there is a need for new methods of SCI information dissemination. Potentially, using primary care providers as conduits for information distribution might improve access to reliable long-term SCI information for caregivers and patients.

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