Prescribing patterns for treating common complications of spinal cord injury

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:

• Spinal cord injury
• Secondary health conditions
• Prescription patterns
• Polypharmacy
• Medication management

Acknowledgements

We would like to thank our participants who volunteered for the study. We also acknowledge the support of various organizations, including the Rick Hansen Institute, Spinal Cord Injury Canada, Canadian Spinal Research Organization, and various others for helping us with the recruitment for the study.

Disclaimer statements

Author Contributions The paper was prepared by SG, who also collected and analyzed data. MAM supervised SG and provided substantial contributions to study conception and design, and data analysis and interpretation. KS and AM are the subject experts and senior authors who contributed to revising the article critically for important intellectual content. All authors contributed towards data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Declaration of interest No conflicts of interest to declare. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Conflicts of interest None.

Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Statement of Ethics Ethical clearance for the study was obtained from the Health Sciences Research Ethics Board (HSREB#912502) of Queen’s University. We certify that all applicable institutional regulations concerning the ethical use of human volunteers were followed during the course of this research.

Additional information

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.