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Spinal cord injury and quality of life: are complementary means useful for it?

Spinal cord injury (SCI) is one of the most disabling and destructive neurological diseases. The clinical outcomes of SCI depend on the severity and location of the lesion. SCI includes partial or complete loss of sensory and/or motor function below the level of injury. According to the World Health Organization, about 250,000 to 500,000 people around the world sustain an SCI each year. The peak age of SCI is about 38 years old, and there are more men than women. Falling from a height is the main cause of SCI, followed by car accident injuries. Permanent spinal cord damage, in time, evolve in several phenomena. For example, neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI; these patients have a 80% chance of developing NBD. Based on the locations of the spinal cord lesions, the NBD can be classified as upper motor neuron dysfunctions (injuries above S1) and lower motor neuron dysfunctions (injuries at S1–S4). Different segments and degrees of SCI can lead to different types NBD, which will lead to different clinical manifestations. Neurogenic bladder may lead to urinary retention, urinary incontinence, and urinary tract infection: in most severe or exrteme cases, it can lead to renal failure and potentially to death.

Given that neurogenic bladder is just one among other problematic SCI complication, and that medicine is still struggligf with pharmacology and biomedicine to find valuable solution, to maintain an acceptable quality of life is central to patients with chronic SCI. The use of complementary and integrative healthcare (which includes healthcare approaches typically seen as outside of conventional medical care or traditional Western medical practices) is on the rise. People with spinal cord injury, in particular, are using alternative therapies, often in an attempt to relieve pain. Yet there is very little scientific evidence for the efficacy of most approaches, and even less evidence for their safety, specifically for people with spinal cord injury, whose concurrent treatments and functional limitations may present additional risks as compared to the general population. In a cross-sectional self-report study led by experts from five Spinal Cord Injury Model Systems Centers, a survey of people with spinal cord injury revealed that 80% of participants were current or previous users of complementary and integrative healthcare approaches such as multivitamins, massage and acupuncture.

Because there is little data regarding the safety and efficacy of use among this population (and because their risk of contraindication may be higher), researchers urge rehabilitation clinicians to be aware of this trend and to initiate dialogues with patients about these therapies to ensure their health and safety. This study is the first to systematically assess complementary and integrative healthcare in people with SCI. In an analysis of an online survey completed by 411 participants with spinal cord injury, the research team characterized how often and why people try using therapies that are not prescribed by their clinicians. Reported complementary and integrative healthcare approaches comprised a wide range of types, with the most common being multivitamins, followed by massage, cannabis, vitamin D, cranberry extract, and vitamin C. The most common reasons for current use were general health and wellness, pain, bladder management, and to improve mobility, flexibility, and strength, though a variety of other reasons were also reported, ranging from respiratory function to mental health. Among participants who reported not trying complementary and integrative healthcare approaches, the primary reason was not knowing what options were available.

Dr. Jennifer Coker, Craig’s Rocky Mountain Regional Spinal Cord System, explained: “Nearly 70% of participants reported that they were currently using a form of complementary and integrative healthcare, whereas fewer than half reported using non-traditional therapies prior to their injury. This tells us that people with spinal cord injury are eager for information about and access to alternative therapies, and we need to be able to provide rehabilitation clinicians with up to date and accurate information about what’s safe and effective and what’s not”. Dr. Botticello at Kessler’s Northern New Jersey Spinal Cord System, added: “There are still important questions to address. Are people with spinal cord injury using complementary and integrative healthcare because it makes them healthier, meaning they experience fewer problems from secondary conditions? Or are people who experience more secondary health conditions using these approaches attempting to treat those conditions? There is clearly a need and opportunity to educate people with spinal cord injury and their health care providers about the potential use of complementary and integrative healthcare interventions. Expanding the toolbox of interventions available to address complications and maximize well-being would be a great benefit”.

Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific references

Burns TC, Quinones-Hinojosa A. Brit Med J. 2021; 373:n955.

Lin Q et al. Medicine (Baltimore) 2021 Jun; 100(24): e26424.

Coker J et al. Arch Phys Med Rehab 2021 May 28.

Dott. Gianfrancesco Cormaci
- Laurea in Medicina e Chirurgia nel 1998 (MD Degree in 1998) - Specialista in Biochimica Clinica nel 2002 (Clinical Biochemistry residency in 2002) - Dottorato in Neurobiologia nel 2006 (Neurobiology PhD in 2006) - Ha soggiornato negli Stati Uniti, Baltimora (MD) come ricercatore alle dipendenze del National Institute on Drug Abuse (NIDA/NIH) e poi alla Johns Hopkins University, dal 2004 al 2008. - Dal 2009 si occupa di Medicina personalizzata. - Guardia medica presso strutture private dal 2010 - Detentore di due brevetti sulla preparazione di prodotti gluten-free a partire da regolare farina di frumento immunologicamente neutralizzata (owner of patents concerning the production of bakery gluten-free products, starting from regular wheat flour). - Responsabile del reparto Ricerca e Sviluppo per la società CoFood s.r.l. (leader of the R&D for the partnership CoFood s.r.l.) - Autore di un libro riguardante la salute e l'alimentazione, con approfondimenti su come questa condizioni tutti i sistemi corporei. - Autore di articoli su informazione medica e salute sui siti web salutesicilia.com, medicomunicare.it e in lingua inglese sul sito www.medicomunicare.com
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