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.

中文翻译：

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治疗脊髓损伤常见并发症的处方模式

客观的：

本研究的目的是找出最常用和最不常用的处方药，用于治疗与脊髓损伤 (SCI) 相关的继发性健康并发症；并确定总体多重用药率和与之相关的风险因素。

设计：

观察设计，横截面分析。

环境：

社区; 加拿大。

参加者：

脊髓损伤患者（n  = 108）。

结果：

总共向包含 213 种不同药物的样本发出了 515 份处方，以治疗 10 种 SCI 相关并发症。四十五名 (45%) 参与者同时服用了 5 种以上的药物。未发现服用药物的数量与年龄、性别、受伤程度、受伤的完整性、受伤后的时间或受伤原因之间存在关联。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）和呋喃妥因（Macrobid）分别是治疗这三种病症的最常用处方药。总样本的 35% 接受了两种或更多种镇痛药的组合，包括阿片类药物中的四线药物（氢吗啡酮、氢可酮和吗啡）。同样，一些参与者被开具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，这通常不推荐用于 SCI 患者。我们将这些处方模式与可用的临床实践指南进行比较，并在考虑 SCI 药物管理的复杂性的同时强调处方超出推荐临床实践的领域。

结论：

SCI 中的药物管理很复杂。需要工具使处方者能够选择基于证据的医疗方案，并为他们的 SCI 患者开出可能不合适的药物。