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 lesion level. According to the WHO, 250,000 to 500,000 people around the world undergo SCI every year. The maximum age of SCI is around 38 and there are more men than women. Falling from a height is the leading cause of SCI, followed by traffic accident injuries. Permanent damage to the spinal cord, over time, evolves into various phenomena. For example, neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI; these patients have an 80% chance of developing NBD. Based on the locations of spinal cord injuries, NBD can be classified as upper motor neuron dysfunction (injury above S1) and lower motor neuron dysfunction (injury at S1-S4). Different segments and grades of LM can lead to different types of NBD, which will lead to different clinical manifestations.
Neurogenic bladder can lead to urinary retention, urinary incontinence, and urinary tract infection – in severe or extreme cases, it can lead to kidney failure and potentially death. Given that neurogenic bladder is just one of the other problematic complications of SCI and that medicine is still struggling with pharmacology and biomedicine to find viable solutions, maintaining an acceptable quality of life is critical for patients with chronic SCI. The use of complementary and integrative health care (which includes health approaches generally considered outside of conventional medical care or traditional Western medical practices) is on the rise. People with spinal cord injuries, in particular, use alternative therapies, often in an effort to relieve pain. Yet there is very little scientific evidence for the effectiveness of most approaches, and even less evidence for their safety, particularly for people with spinal cord injuries, whose functional limitations may present additional risks compared to the general population.
An option that has been under consideration for some time is the use of traditional Chinese medicine, which has been widely practiced in East Asia for thousands of years. There is no doubt that Chinese medicine made a great contribution to human health, especially in ancient times. However, with the passage of time, the development of Chinese medicine has lagged behind. However, Chinese medicine is gaining attention as a complementary and alternative medicine due to its good tolerability, few side effects, and low cost. Indeed, the efficacy of Chinese medicine treatments has been demonstrated for some diseases refractory to conventional therapies. A review published late last year investigated the overall effectiveness of Chinese medicine methods on the neurological bladder. He was thus able to ascertain that electroacupuncture has an important role in improving the reflex of urination after SCI and, in turn, accelerates the recovery of bladder function.
Among the various herbal formulations analyzed, it was found that tanshinone IIA, the active ingredient of the Chinese herb “Danshen” (the common Salvia miltiorrhiza), improves the urodynamic parameters and the functional recovery of the bladder after neurological bladder induced by LMS, reducing inflammation and edema of the bladder tissue and improving the regeneration of the spinal cord. In a different type of cross-sectional self-assessment study conducted by experts from five spinal cord injury modeling systems centers, a survey of people with spinal cord injury revealed that 80% of the participants were current or previous users of approaches. complementary and integrative health care such as multivitamins, massage and acupuncture. As there is little data regarding the safety and efficacy of use in this population (and because their risk of contraindication may be higher), researchers urge rehabilitation physicians to be aware of this trend and to engage in dialogue with patients on these therapies to ensure their health and improve their quality.
This study was the first to systematically evaluate complementary and integrative health care in people with SCI. In an analysis of an online survey completed by 411 participants with spinal cord injuries, researchers investigated how often and why people try to use therapies not prescribed by their doctors. Complementary approaches reported included a wide range of types, with the most common multivitamins, followed by massage, cannabis, vitamin D, cranberry extract, and vitamin C. The most common reasons for current use were general health and wellbeing. pain, bladder management, and to improve mobility, flexibility, and strength, although mental health reasons have also been reported. Among the participants who reported that they had not tried complementary and integrative health approaches, the main reason was not knowing what options were available. Nearly 70% of participants reported currently using a complementary and integrative form of health care, while less than half reported using non-traditional therapies prior to injury.
This suggests that people with spinal cord injuries are eager for information and access to alternative therapies. It is certainly frustrating to undergo an LMS, especially for those who are temperamentally enterprising, dynamic and with a busy life. For them, functional impotence can turn into a real mental trauma and lead them to depression and feelings of despair. A newly published study from the University of Michigan concluded that people living with a spinal cord injury were diagnosed with a mental health condition more often than those without the injury: 59.1 percent versus 30.9 percent. Although depression and negative mental health effects are not inevitable consequences of every traumatic spinal injury, past findings have consistently echoed higher levels of psychological morbidity in this group than in the healthy general population. In this study, however, centralized and neuropathic chronic pain was found to be strongly associated with post-traumatic stress disorder, drug or medication abuse, and other mental health conditions.
It is well known that for a slice of these patients, antidepressant drugs may have no desired or no effect whatsoever. Therefore, the use of supplementary options that, together with standard therapy, can show results and improvements, albeit very small and gradual, can be beneficial for the quality of life of these patients, as well as for their mental health.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
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