Neuropathic pain in spinal cord injury:topical analgesics as a possible treatment

STUDY DESIGN: Review of the literature and semi-structured interviews. OBJECTIVE: To explore the possible use of topical analgesics for the treatment of neuropathic pain (NP) in spinal cord injury (SCI). SETTING: Institute for Neuropathic Pain, Soest, The Netherlands. METHODS: A review was performed of studies on topical analgesics for SCI-related NP published up to May 2019. In addition, eight persons with SCI-related NP who were treated with topical analgesics were interviewed in a semi-structured interview on their experience with topical analgesics. RESULTS: Seven studies (five case reports and two case series) were found that evaluated the use of topical analgesics for SCI-related NP. None of the studies used a control treatment. Topical analgesics included baclofen, ketamine, lidocaine, capsaicin, and isosorbide dinitrate. All studies reported a decrease in NP over time. Persons interviewed were 49-72 years of age and all but one had an incomplete SCI. They used topical agents containing phenytoin, amitriptyline, baclofen, ketamine or loperamide. All showed a decrease in pain of at least 3 points on the 11-point numeric rating scale during this treatment. DISCUSSION/CONCLUSIONS: Evidence on the use of topical analgesics in SCI is scarce. Case reports, case series and interviews suggest that the use of topical analgesics can be beneficial in treating SCI-related NP. Placebo-controlled studies are required to investigate the effect of topical analgesics on SCI-related NP

Spinal cord injuries and bowel stomas:timing and satisfaction with stoma formation and alterations in quality of life

STUDY DESIGN: Cross-sectional study.OBJECTIVES: Neurogenic bowel dysfunction (NBD) is frequent among individuals with spinal cord injury (SCI) and is often difficult to treat. A bowel stoma is considered the last-resort treatment option for individuals with SCI and severe NBD. This study aims to explore whether individuals are satisfied with their bowel stoma and how they feel about the timing of stoma formation. Furthermore, we want to explore side effects addressing diversion colitis and changes in quality of life (QOL) after stoma formation.SETTING: Netherlands, community.METHODS: We included participants aged at least 18 years with a traumatic or non-traumatic SCI and bowel stoma. Questions regarding timing of stoma formation, alterations in QOL after stoma formation and experienced side effects of the bowel stoma were addressed in an online questionnaire.RESULTS: In total 23 participants filled out the online survey. Twenty-two participants (96%) were satisfied with their bowel stoma and 83% felt their stoma was placed too late or far too late. The large majority (&gt;80%) reported improvements in the four QOL domains after the procedure. Nine participants reported stoma-related problems in the last month. In the last three months, seven participants (30%) reported to have diversion colitis. Four of these seven participants experienced this at least once a week or more. Two participants stated this had moderate influence on daily activities.CONCLUSIONS: Most participants with SCI experienced improvement in QOL and in retrospect wanted their bowel stoma earlier. Early, extensive conversations to inform individuals about bowel stoma as a treatment option is recommended.</p

Post-traumatic stress disorder symptoms and pain intensity in persons with spinal cord injury

Study design Cross-sectional. Objectives To examine the association between post-traumatic stress disorder (PTSD) symptoms and pain intensity, taking symptoms of anxiety and depression into account within persons with spinal cord injury (SCI). Setting Persons with SCI, who visited a Dutch rehabilitation centre between 2005 and 2010, were invited to complete a survey. Methods PTSD symptoms were measured with the Trauma Screening Questionnaire (TSQ), pain intensity with an 11-point Numerical Rating Scale (NRS), and symptoms of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). To determine associations between PTSD symptoms and pain intensity, linear regression analyses were performed. Confounding variables representing anxiety and depression were added to the final model. Results In total, 175 participants (55.8% traumatic, 29.1% complete) were included (response rate of 31.7%). Of them, 11.4% had clinically relevant symptoms of probable PTSD (TSQ score >= 6) 69.8% experienced moderate to severe pain levels (NRS >= 4), 14.9% had symptoms of anxiety and 20.8% symptoms of depression (HADS scores >= 11). Levels of PTSD symptoms were strongly associated with symptoms of anxiety (0.54) and depression (0.49). Bivariate analyses showed a moderate significant association (0.30) between PTSD symptoms and pain intensity. This association became small (0.10) when anxiety and depression comorbidity were factored into the final regression model. Conclusions No independent association between PTSD symptoms and pain intensity was shown when adjusted for anxiety and depression. Results of this study suggest the usefulness of screening for PTSD in persons with SCI (regardless of injury cause or type/level) who score high on symptoms of anxiety/depression

The impact of age and comorbidity on the progression of disability in late-onset sequelae of poliomyelitis

Item does not contain fulltextOBJECTIVES: To describe the functional course over 5 years in patients aged 45 to 85 years with late-onset sequelae of poliomyelitis (LOSP) and to explore the impact of age and comorbidity. DESIGN: Prospective cohort study with 5 measurements over 5 years. SETTING: University hospital. PARTICIPANTS: Subjects with LOSP (N=168). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM, Medical Outcomes Study 36-Item Short Form health survey for physical functioning subscale (SF-36-PF), walking test, isokinetic quadriceps strength, and cumulative illness rating scale (CIRS) for comorbidity. RESULTS: The FIM score (mean baseline +/- SD, 121+/-4) and SF-36-PF (mean baseline +/- SD, 39.5+/-24) decreased 2.2 and 3.7 points, respectively, over 5 years independent of age. The distance walked in 2 minutes (mean baseline +/- SD, 126.2+/-34m) decreased 4.5m, quadriceps strength (mean baseline +/- SD, 88.0+/-42.2Nm) declined 7Nm (8%), and CIRS (median baseline=6; range, 0-21) increased 1.5 points. A higher CIRS score was correlated with a lower FIM score and faster decrease in the FIM. A longitudinal model of factors associated with the FIM included sex, age, leg strength sum-score, arm strength sum-score, and CIRS score. The interaction of CIRS and leg strength sum-score with follow-up time was significant. A model of factors associated with SF-36-PF included sex, age, leg strength sum-score, and CIRS score. CONCLUSIONS: Despite a reduction in muscle strength, disability increased little in patients with LOSP. Increased age and comorbidity has a negative effect on disability. Comorbidity and the severity of leg paresis affected the course of functional independence but not the course of perceived physical functioning.1 april 201

Sf36 physical functioning scale and 2-minute walk test advocated as core qualifiers to evaluate physical functioning in patients with late-onset sequelae of poliomyelitis.

OBJECTIVE: To select a questionnaire and walking capacity test based on comparison of clinimetric properties and mutual association to be used as "core" qualifiers for physical functioning in patients with late-onset sequelae of poliomyelitis. DESIGN: Repeated-measures at 3-week intervals. SUBJECTS: An unselected sample of 57 patients with late-onset sequelae of poliomyelitis from a prospective cohort study. METHODS: Physical functioning scales from Short Form-36 (SF36-PF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC-PF) and Nottingham Health Profile (NHP-PM). Timed-Up-and-Go test, 10-m walking at self-preferred and maximum speed, and 2-min walk test. RESULTS: Test-retest reliability of SF36-PF and WOMAC-PF was good (intraclass correlation coefficient (ICC) 0.92 and 0.89, respectively), sufficient for NHP-PM (ICC 0.74) and excellent for walking tests (ICC 0.93-0.96). The smallest detectable changes were 18.4 and 16.5, respectively, for WOMAC-PF and SF36-PF, and 26.7 for NHP-PM. The smallest detectable change was best for the 2-min walk test (22.9 m). Correlation coefficients between questionnaires and walking tests ranged from 0.32 to 0.69, with the highest correlation between the SF36-PF and 2-min walk test. CONCLUSION: The SF36-PF and 2-min walk test are recommended as core qualifiers for physical functioning, the major increasing disability in late-onset sequelae of poliomyelitis, to assess perceived physical performance and walking capacity in research and clinical practic

Is Fitbit Charge 2 a feasible instrument to monitor daily physical activity and handbike training in persons with spinal cord injury?:A pilot study

Study design: It is a longitudinal pilot study.Objectives: To investigate the feasibility of a low-cost and widely used fitness tracker with step count and heart rate data to monitor daily physical activity in wheelchair users with spinal cord injury (SCI).Setting: Dutch community.Methods: Six participants with SCI who were in training for a handbike event were recruited. They were asked to wear a Fitbit Charge 2® 24 h a day for at least 2 weeks and were questioned about the utility and user-friendliness of this device.Results: Five out of six participants managed to wear the device nonstop for 2 weeks, and continued to wear the device after this initial period. Most participants were enthusiastic about the direct feedback provided by the tracker and reported the data to be accurate. Data collected during more than 2 months of three participants and during 8 months on one of them showed the possibility of detecting training days and observing interpersonal and intrapersonal variation in daily physical activity level.Conclusions: A commercially available, low-cost, self-monitoring multi-sensor wrist device or a fitness tracker like the Fitbit Charge 2® can be a promising instrument to monitor daily activity levels among wheelchair users with SCI. The free commercial dashboard and log data clearly show trends of variations in physical activity and increases in heart rate, which are of value to both researchers and clinicians interested in identifying training schedules of wheelchair athletes.</p

Is Fitbit Charge 2 a feasible instrument to monitor daily physical activity and handbike training in persons with spinal cord injury? : A pilot study

Study design: It is a longitudinal pilot study. Objectives: To investigate the feasibility of a low-cost and widely used fitness tracker with step count and heart rate data to monitor daily physical activity in wheelchair users with spinal cord injury (SCI). Setting: Dutch community. Methods: Six participants with SCI who were in training for a handbike event were recruited. They were asked to wear a Fitbit Charge 2® 24 h a day for at least 2 weeks and were questioned about the utility and user-friendliness of this device. Results: Five out of six participants managed to wear the device nonstop for 2 weeks, and continued to wear the device after this initial period. Most participants were enthusiastic about the direct feedback provided by the tracker and reported the data to be accurate. Data collected during more than 2 months of three participants and during 8 months on one of them showed the possibility of detecting training days and observing interpersonal and intrapersonal variation in daily physical activity level. Conclusions: A commercially available, low-cost, self-monitoring multi-sensor wrist device or a fitness tracker like the Fitbit Charge 2® can be a promising instrument to monitor daily activity levels among wheelchair users with SCI. The free commercial dashboard and log data clearly show trends of variations in physical activity and increases in heart rate, which are of value to both researchers and clinicians interested in identifying training schedules of wheelchair athletes