School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
Department of Physical Medicine and Rehabilitation, School of Medicine, Queen's University, Kingston, Canada.
J Spinal Cord Med. 2023 Mar;46(2):237-245. doi: 10.1080/10790268.2021.1920786. Epub 2021 May 6.
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.
Observational design, cross-sectional analysis.
Community; Canada.
Individuals with spinal cord injury (= 108).
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.
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.
本研究旨在找出治疗与脊髓损伤（SCI）相关的继发性健康并发症最常和最不常开的药物，并确定总体多药治疗率及其相关风险因素。
观察性设计，横断面分析。
社区；加拿大。
脊髓损伤患者（n=108）。
对样本共开出 515 份处方，包含 213 种不同的药物，用于治疗 10 种与 SCI 相关的并发症。45（45%）名参与者同时开了>5 种药物。服用药物的数量与年龄、性别、损伤水平、损伤程度、损伤后时间或损伤原因之间均无关联。最常治疗的并发症包括疼痛（56.5%）、肌肉痉挛（54%）和尿路感染（43%）。抗惊厥药（普瑞巴林、加巴喷丁）、抗痉挛药（巴氯芬、地西泮）和硝基呋喃妥因（Macrobid）分别是治疗这三种疾病最常开的药物。总样本的 35%接受了两种或两种以上止痛药的联合治疗，包括阿片类药物中的第四线药物（氢吗啡酮、氢可酮和吗啡）。同样，一些参与者被开了一般肌肉松弛剂和头孢菌素，分别用于治疗肌肉痉挛和尿路感染，而这些药物在 SCI 患者中一般不推荐使用。我们将这些处方模式与现有的临床实践指南进行比较，并强调了在考虑 SCI 患者药物管理的复杂性的情况下，处方超出推荐临床实践的情况。
SCI 的药物管理很复杂。需要工具来帮助开处方者为 SCI 患者选择基于证据的医疗方案，并减少潜在的不适当药物。
