Medical Complications After Spinal Cord Injury: Spasticity, Pain, and Endrocrine/Metabolic Changes

Abstract

Recognition and proper management of medical complications after spinal cord injury (SCI) will improve both quality of life and health. Spasticity often interferes with comfort, function, and quality of life after SCI. Spasticity can be effectively reduced by various therapies that may be applied by the pyramid approach, starting with nonpharmacologic and noninvasive methods before proceeding to treatments with systemic medications, intrathecal administration of drugs, or nerve blocks by injection of chemicals. Pain is also a common complaint after SCI but has multiple causes, and consequently diverse treatment approaches are needed. Accurate classification of pain in persons with SCI is essential to select the appropriate management and to evaluate results of treatment. In recent years, two classification systems have emerged that address nociceptive and neuropathic pain and, to various extent, categorize pain according to its location. Based on the specific pain type, different treatment strategies are subsequently selected. The abnormalities in carbohydrate and lipid metabolism in persons with SCI are atherogenic. Disorders of carbohydrate metabolism occur with increased frequency in persons with SCI compared to those who are able-bodied. Persons with SCI generally have adverse body composition changes (increased adiposity and decreased lean tissue mass) and are less active than the general population, which are the determinants of insulin resistance. The deterioration in carbohydrate handling is associated with insulin resistance and compensatory hyperinsulinemia. Patients with the greatest neurological deficits (complete tetraplegia) have worse carbohydrate tolerance and higher plasma insulin levels than other neurological subgroups. A low serum HDL cholesterol level is an independent risk factor for coronary heart disease, and the prevalence of low serum HDL cholesterol levels is greater in persons with SCI than in those who are able-bodied. Individuals with complete, higher lesions tend to have lower levels of serum HDL cholesterol. However, men with SCI had lower serum HDL cholesterol levels than able-bodied control participants, but women with SCI did not have an adverse lipid profile. A relationship exists between insulin resistance and HDL cholesterol: the greater the insulin resistance, the lower the serum HDL cholesterol level. An indirect relationship has been demonstrated between abdominal circumference and serum HDL cholesterol levels and a direct relationship with serum triglycerides. Increased cardiopulmonary fitness has been shown to favorably affect the lipid profile. Persons with SCI should have a complete lipid profile at least once every 5 years and therapeutic intervention with diet and/or exercise should be begun, if indicated.