Return to home page
The Pharmaceutical Journal Vol 263 No 7073 p877
November 27, 1999 Forum

United Kingdom Clinical Pharmacy Association

Pharmaceutical care of patients with spinal injuries

Progress in practice - The UKCPA autumn symposium was held in Blackpool on November 19-21, 1999

Patients with spinal cord injuries (SCIs) presented a unique combination of problems for pharmaceutical care delivery, said Mr ADRIAN BROWN (chief pharmacist, Southport hospital) at a workshop session about spinal care. Most patients had no significant medical history; they were most often young, healthy males who sustained SCIs in road traffic accidents. Care of patients with SCIs was aimed towards maintaince in the community.
The acute consequences of SCIs were spinal shock (which involved a loss of control of all reflexes), paralysis, urine retention and spasticity. The degree of paralysis depended on the site of the spinal cord lesion; higher lesions were more serious. Paraplegia was paralysis in the legs and tetraplegia was a loss of function of all four limbs. If a lesion was particularly high in the spinal cord, there could be a paralysis of the diaphragm leading to breathing problems. Spasticity occurred because reflexes were exaggerated; the loss of connection to the brain meant that it could not override reflex arcs, so reflexes occurred inappropriately.

photo of Adrian Brown
Adrian Brown: works on a spinal care unit

Following a spinal cord injury, patients were stablilised in intensive care and were given fluids and oxygen.
The medium term consequences of SCIs were thromboembolic disease, pressure sores, bladder problems, loss of blood pressure control (controlled by dopamine or atropine), mucous accumulation in the lungs, infections, pain and constipation. Thromboembolic disease was prevented, once there was no bleeding around the SCI, with heparin and later warfarin. Most patients needed catheterisation due to either a hyper-reactive or a flaccid bladder (which occurred depended on the site of the lesion). Mucolytics were used to clear mucous in the lungs which accumulated because of a loss of coughing reflex. Despite the loss of sensation, patients could still be in intense pain and this was often associated with spasticity. Pain was treated with anticonvulsants, tricyclic antidepressants and benzodiazepines.
The longer term issues to consider were bladder care, constipation, sexual problems, skin care, psychological problems and pain and spasticity. Catheterisation was still needed and, in addition, the anticholinergic drugs oxybutynin and tolterodine were used. Cholinergic drugs and alpha blockers (used outside their licence) were given for flaccid bladders. Baclofen, dantrolene or tizanidine were given to treat spasticity.

Other items from the UKCPA symposium