The journal of spinal cord medicine
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Randomized Controlled Trial Clinical Trial
The effects of sildenafil on the cardiovascular response in men with spinal cord injury at or above the sixth thoracic level.
Sildenafil is efficacious for erectile dysfunction in men with spinal cord injury (SCI), but can induce hypotension in neurologically intact people. Those with SCI at or above the sixth thoracic level (T6) often have pre-existing hypotension, yet the cardiovascular response to sildenafil has not been studied in this group. ⋯ Sildenafil induces significant hypotension in people with cervical-level injuries--more so than in thoracic-level injuries--and can cause dizziness in both populations. It should be prescribed with caution and informed consent from the patient.
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Below-level central neuropathic pain, a diffuse pain characterized by generalized burning, is commonly experienced by individuals with spinal cord injury (SCI). The objective of this study was to investigate the effects of an electroacupuncture protocol for the treatment of below-level central neuropathic pain developed at the Toronto Rehabilitation Institute, Lyndhurst Center, Toronto, Ontario, Canada. ⋯ This retrospective study suggests that the Lyndhurst Center Central Neuropathic Pain Acupuncture Protocol may be an effective treatment option for patients with SCI who are experiencing below-level central neuropathic pain. Additional prospective clinical studies are needed to confirm these findings.
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Review Case Reports
Managing spasticity in spinal cord injury: safe administration of bridge boluses during intrathecal baclofen pump refills.
Intrathecal baclofen now plays an important role in the management of spasticity in a number of neurologic conditions including spinal cord disorders. Dosage errors can be a source of significant morbidity and the risk is greatest when the clinician is changing solution concentration. When changing concentrations, it is imperative to program the pump correctly by incorporating a bridge bolus to compensate for the residual baclofen solution in the pump and catheter. This paper reviews the appropriate methods to safely calculate the bridge bolus, with an illustrative example.
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Case Reports
Phenazopyridine in the management of autonomic dysreflexia associated with urinary tract infection.
Documentation of possible usefulness of phenazopyridine in the management of autonomic dysreflexia (AD) associated with urinary tract infection. ⋯ Phenazopyridine may be useful in the management of AD associated with cystitis.
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Randomized Controlled Trial Clinical Trial
Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial.
Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI. ⋯ Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.