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COMMON COMPLICATIONS OF SPINAL CORD INJURY: PNEUMONIA AND PAIN
Pneumonia
In people with spinal cord injury, difficulty coughing (and thus clearing the lungs), prolonged bed rest, and decreased mobility all contribute to an increased risk of developing pneumonia. Several treatments are used for patients who contract pneumonia. A combination of antibiotics and vigorous respiratory therapy is the first choice. The respiratory therapist pounds with both hands on your chest or back while you are tilted at an angle to help drain the affected lobe of the lung. This is called postural drainage. Inhalants are also used to help dilate and clear airway passages.
People with quadriplegia usually need assistance with coughing to prevent or treat pneumonia. In a technique known as quad coughing, the caregiver pushes on your upper abdomen while you cough, and this helps to expel air forcefully from the lungs.
Pain
Most individuals with spinal cord injury have to deal with pain at some point during the recovery process. For most, the pain is transient and is associated with the initial trauma (for example, the pain caused by a vertebral fracture or an associated injury). This pain may persist for weeks, but it generally is responsive to traditional analgesic medications (painkillers) and resolves over time. However, many individuals have chronic pain after spinal cord injury that is disabling and difficult to treat. This dysesthesia, or neurogenic pain, is caused by abnormal processes inside the spinal cord, not by a pain-inducing stimulus outside the body. Neurogenic pain is particularly frustrating because it commonly affects an area of the body that is anesthetic?that is, a region that has no sensation whatsoever for external stimuli. Individuals with neurogenic pain describe it as feeling like burning, tingling, or an electric shock, sometimes very intense. They often say that it’s unlike any sensation they have experienced before.
Neurogenic pain is difficult to treat. It sometimes responds to traditional analgesic medications, but it may be resistant to these. Narcotic painkillers are sometimes necessary but are not always effective. Several medications not usually classified as painkillers may help with this sort of pain. Certain antidepressant drugs, particularly tricylic antidepressants (such as amitriptyline), have been used successfully in treating neurogenic pain. The other medications with proven efficacy for neurogenic pain are certain antiepileptic drugs, especially Neurontin (gabapentin). Psychological approaches, such as relaxation and imagery training, can also be useful for dealing with chronic pain.
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