Medication is not as effective as physical therapeutic interventions after spinal cord injury, researchers have found, with promising approaches to alleviate symptoms of spasticity also being identified.
A team of researchers representing six Spinal Cord Injury Model System Centers across the United States found that the lived experiences of people with spasticity after spinal cord injury were complex and multidimensional, but certain commonalities – such as stiffness, rather than spasms, as the most problematic characteristic – can inform further studies to identify effective treatments.
The research “Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers” brings together leading experts in the field from across the United States and the world.
Chronic spasticity – characterised by uncontrolled tightening or contracting of muscles – affects most people with spinal cord injury. Its effects range from restricting ability to perform daily activities and pain to negative self-image, and anti-spasmodic medications are often prescribed to mitigate symptoms.
However, data was lacking regarding the lived experience of people with spasticity and the value of medication as a management strategy. To better address this common secondary condition, researchers and clinicians needed more information.
For the study, researchers conducted an online cross-sectional survey of 1,076 people in the US with spinal cord injury. Their aim was threefold: to identify the characteristics of spasticity that have the greatest impact on daily life and function; to describe relationships among characteristics of spasticity and injury-related attributes, and to gauge the perceived value of spasticity management strategies.
“Our goal was to characterize the qualities that people with spinal cord injury associate with their experience of spasticity, and to describe the relationship between spasticity and perceived quality of life,” said Dr Edelle C. Field-Fote, of Shepherd Center’s Crawford Research Institute and Emory University School of Medicine.
“We found that there are five most common problematic experiences: stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. We also learned that stiffness associated with spasticity was more common than spasms.”
The survey results clarified a range of touchpoints about how spasticity affects daily life.
Participants reported that spasms most often occurred in response to movement-related triggering events, though participants also reported that spontaneous spasms were also among the most common types.
Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56 per cent of respondents under 25 years old, decreasing to 28 per cent among those over age 55. Most respondents reported using a combination of approaches for spasticity management.
According to Dr Trevor Dyson-Hudson, director of the Centers for Spinal Cord Injury Research and Outcomes & Assessment Research at Kessler Foundation: “What was interesting is that participants reported stretching and exercise as more likely to improve spasticity than medication.
“With more than 90 per cent of participants reporting daily stiffness and/or spasms, we need to emphasize these promising approaches and continue to investigate how we can help people with spinal cord injury manage their spasticity.”
Because stiffness was reported to be the most problematic aspect of spasticity and participants indicated that physical therapeutic interventions were more valuable than medications, the authors emphasize the importance of further study of non-pharmacological treatment approaches that can effectively manage stiffness.
They also recommend identifying approaches for measurement of stiffness, which would be a valuable metric in determining appropriate interventions.
