MANAGING MEDICATION

Quadriplegics typically take medication for nerve pain. Nerve pain can feel like burning, tingling, and even like open wounds.

The main medicines recommended for neuropathic pain include antidepressants (amitriptyline, duloxetine) and anticonvulsants (gabapentin, pregabalin). They work by interfering with chemical processes in your brain and spinal cord that cause you to feel pain.

Side effects of antidepressants may include dry mouth, nausea, drowsiness, dizziness, decreased appetite, constipation, and a whole lot more. Some side effects can be very serious and require emergency treatment, like inability to speak, labored breathing, loss of balance control and even loss of consciousness.  

Anticonvulsant side effects can range from diarrhea and insomnia to life-threatening breathing problems or changes in your mood and suicidal thoughts.

While some quadriplegics report these medications to be helpful and side effects to be minimal, many also say they don’t work at all, except to cloud the mind, causing disorientation and disinterest, tiredness, and memory loss. They can also cause weight gain.

Some quadriplegics find regular pharmaceutical painkillers do the trick. We advise using caution when trying opioid painkillers for nerve pain. These include Fentanyl, Hydrocodone (Lortab, Norco, Vicodin) and Morphine. 

Medications containing opioids can lead to dependence so these drugs are usually prescribed only as a last resort. Opioids can also be dangerous to mix with benzodiazepines.

Topical treatments sometimes work for nerve pain:

Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in neuropathy symptoms. Sometimes the cream can burn the skin but this typically lessens over time. 

Lidocaine patches might offer pain relief, but the side effects can include drowsiness, dizziness and numbness at the site of the patch.

Cannabis creams can help with nerve pain as well as muscle, joint and arthritis pain.

Some quads smoke cannabis and find relief although doing so does prohibit wound healing and can cause respiratory issues. (See the section on Cannabis below.)

Ketamine infusions have been known to help pain as well. Ketamine is an anesthetic medication that, in low doses, helps "reset" the nervous system's pain pathways.   

When it comes to nerve pain, some quadriplegics prefer just living with the pain, over taking drugs. We swear that distraction is the only real antidote.

Many quadriplegics take medication like muscle relaxers and/or benzodiazepines to decrease spasticity and spasms. Anticonvulsants which help with nerve pain, which we just discussed, can sometimes help with spasms and spasticity, too. 

Left untreated spasticity (basically, stiffness) can lead to deformities and contractures and be difficult to correct. Spasticity can be triggered at any time through a variety of stimuli. Constipation, urinary tract infections, and pressure ulcers may make spasticity worse. 

Baclofen is the popular spasticity med. It seems to block nerve signals from the spinal cord that cause muscles to spasm. Side effects can include drowsiness, dizziness, weakness, and fatigue. 

Tolerance builds and higher doses are needed. High dosing for a long time is bad for the liver. Oral baclofen is not recommended for elderly patients either, because of drowsiness.

High doses of baclofen can cause disorientation and impair memory, especially in combination with gabapentin or pregabalin.

Some quadriplegics with spasticity use a baclofen pump. Baclofen is administered 24 hours a day via an implantable pump. You can take significantly less baclofen because the catheter extends right into the spinal fluid. It can work to combat nerve pain as well.

Often benzodiazepines are used too. Typically benzodiazepines are used to treat anxiety, but because they reduce the activity of nerves in the brain and spinal cord, they can work for spasticity too. 

Diazapam (Valium) and Lorazepam (Ativan) are benzodiazepines frequently prescribed to quadriplegics with spasticity. They’re sedative and can cause drowsiness and fatigue.

Benzodiazepines are particularly addictive and should be dosed under physician’s supervision. They are also dangerous to take alongside opioids.

Dantrolene and Tinazidine are among other muscle relaxers prescribed for spasms. Side effects can include drowsiness, dizziness, lightheadedness, and fatigue.

Overwhelmed? You will be, when doctors start pushing all these on you. Ask your doctor about all the side effects of your medications and discuss how any two drugs could interact with one another. Discuss tapering down or increasing dosages with your doctor too, to minimize side effects but still get the relief you need.

Many quadriplegics have turned to cannabis for both nerve pain and spasticity, instead of a bunch of pills.

Cannabis is legal to use but if you want to avoid psychotropic effects you can try products with CBD instead of THC. Both are cannabinoids found in cannabis. Although no major studies attest to it yet, many members of the spinal cord injury community indicate that CBD can be great for relaxing your muscles and relieving spasms and nerve pain.

Cannabinoids work so well with the human body because they bind with cannabinoid receptors within the human endocannabinoid system. Cannabis can reduce levels of inflammatory proteins and suppress the spasm response.

The online spinal cord injury community is very united in our approval of cannabis. When discussing pain and spasticity multiple members chime in quickly.

Cannabis has its drawbacks, too- drowsiness, dependence, hunger, dry mouth, memory issues. But you can choose a strain and method of consumption that provides the least side effects for you. Your body’s response depends on the product type and way you consume it. 

Smoking is not the safest way to consume cannabis. Our diaphragm is already compromised. Some studies have also shown that smoking can also slow down the wound healing process. Pills, patches, edibles and other methods of cannabis consumption that enter the bloodstream have a full-body effect but may take some time to kick in. Edibles avoid the respiratory complications associated with smoke inhalation, but the systemic effects of THC itself can still impact the body's recovery mechanism. Avoid cannabis when healing wounds.

For a super powerful dose try concentrated extracts like RSO (Rick Simpson Oil), a full extract cannabis oil meant to be taken orally, made utilizing a solvent like grain alcohol. Drops are placed under the tongue and absorbed in the mouth. They take approximately 15 to 30 minutes to kick in and are a good choice for discreet use and efficient self-dosing. 

There are hundreds of different strains of Cannabis. Each is considered a sativa, indica, or hybrid of the two. While it is not an exact science, users tend to report more effective pain-relieving properties with indicas when it come to neuropathy, spasticity, and sleep.

“Medicines have done a lot of damage. My short-term memory is shot, my bones are swiss cheese, my teeth now need help and my hair is paper thin. I've now weaned off all meds except Baclofen and a sleep aid. I'm working on both now. I've found my body does not need antidepressants, antispasmodic, neuropathy, pain meds etc... I'm more in tune with my body now more than ever. Please do what is best for you.” Helen, 34 years in 

Some quads may try a TENS (Transcutaneous Electrical Nerve Stimulation) unit for pain. The TENS delivers small electrical impulses through electrodes that have adhesive pads to attach them to your skin. These electrical currents stop the pain signals to the brain. Basically it tricks the brain to ignore the pain for a short duration of time by applying a non-painful stimulus to the same area. The same electrical impulses also stimulate the body to produce natural pain relievers. One of the only risks from TENS is the potential skin irritation that can come from leaving pads on in one place for too long. 

A spinal stimulator for pain may be used, which delivers tiny pulses of electric current to specific nerves on the spinal cord, masking pain signals on their way to the brain. The pain source isn’t stopped, but stimulation changes the way the brain perceives it, making it feel like mild tingling or fluttering, or you may not feel any sensation at all. The amount of pain relief achieved is different for everyone.

You can turn stimulation on and off, and change the level to target different pain areas of the body with a remote control. Thin wires called electrodes are placed between the spinal cord and the vertebrae and a pacemaker like generator is placed under the skin, usually near the buttocks or abdomen.

A baclofen pump, also called an intrathecal baclofen pump, is a surgically implanted device that delivers the muscle relaxant baclofen directly into the fluid surrounding the spinal cord to treat severe spasticity. The small pump, often made by companies like Medtronic, is placed under the skin of the abdomen and connected by a thin catheter to the intrathecal space around the spinal cord.

By delivering medication directly to the spinal fluid rather than through the bloodstream like oral baclofen, it allows for much smaller doses and typically fewer systemic side effects such as drowsiness or brain fog, while providing more effective control of muscle spasms. 

The pump must be refilled periodically through the skin, the dose can be adjusted externally by a clinician, and the battery usually lasts several years before replacement; however, careful monitoring is essential because sudden interruption of the medication can lead to serious withdrawal symptoms, including severe rebound spasticity and medical complications.

Before starting sleep meds, you might want to try some natural methods of dealing with insomnia. Try melatonin and magnesium supplements and herbal teas with chamomile, lavender, lemon balm, passion fruit or valerian root.

The most commonly prescribed medications for sleep include non-benzodiazepine “Z-drugs” such as zolpidem (Ambien) and eszopiclone (Lunesta), and zaleplon (Sonata) but these are typically recommended for short-term insomnia treatment. Benzodiazepines like temazepam may also be prescribed, though they carry higher risks of dependence, tolerance, and next-day impairment.

Another commonly used option is trazodone, an antidepressant often prescribed off-label at low doses for its sedating effects. 

The choice of medication depends on the type of insomnia (difficulty falling asleep versus staying asleep), patient age, medical history, risk of dependence, and potential side effects. Talk with your spinal cord injury medical team.

For quads with recurrent UTIs, low-dose prophylactic antibiotics such as nitrofurantoin or trimethoprim-sulfamethoxazole may be prescribed for daily or post-catheterization use, though long-term use must be carefully monitored due to antibiotic resistance concerns. A non-antibiotic option increasingly used is methenamine hippurate, which helps suppress bacterial growth in acidic urine.

Many quads also use supplements such as cranberry extract or D-mannose, which may reduce bacterial adherence to the bladder wall.

Because prevention strategies vary based on bladder management method (intermittent catheterization, indwelling catheter, suprapubic tube), kidney function, and prior infection history, decisions should be individualized in consultation with a urologist. See an infectious disease specialist if infections persist.

Stool softeners such as docusate may be added, though evidence for effectiveness is mixed. Fiber supplements like psyllium can help regulate stool consistency, but they must be used with adequate fluid intake to avoid worsening blockage.

Some quads also use rectal suppositories or mini-enemas as part of a scheduled bowel routine. Stimulant suppositories such as bisacodyl (often marketed as Dulcolax) and glycerin suppositories. Bisacodyl suppositories are frequently preferred because they typically work within 15–60 minutes. Some bowel programs may also incorporate mini-enemas containing docusate sodium (such as Enemeez).

Medications like midodrine or fludrocortisone may be taken for orthostatic hypotension (low blood pressure).

For high blood pressure during episodes of Autonomic Dysreflexia you may be prescribed Nitroglycerin ointment (nitropaste). It is typically applied only after non-pharmacological steps—such as sitting upright and checking for bladder or bowel triggers—have failed to reduce a systolic blood pressure (SBP) reading above 150 mmHg. It is essential to understand the correct application and safety procedures. 

Apply 1-2 inches of 2% nitroglycerin paste (Nitro-Bid/Nitropaste) to clean, hairless skin above the spinal injury level (chest/arm), using provided paper for measurement and application, then tape, wearing gloves to avoid self-absorption; wipe off when systolic BP drops below 100-130 mmHg or symptoms resolve. 

As a last resort for mental health, you may want to try medication for anxiety or depression.

The most commonly prescribed medications for anxiety are selective serotonin reuptake inhibitors (SSRIs) such as sertraline, escitalopram, and paroxetine, which increase serotonin levels in the brain. They are effective and non-addictive, though they may take several weeks to work.

Serotonin–norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine and duloxetine are also commonly prescribed and work by increasing both serotonin and norepinephrine.

For short-term or acute anxiety relief, benzodiazepines like lorazepam may be used, though they carry risks of tolerance and dependence. Other options include buspirone, which is non-sedating and non-addictive but works more gradually, and certain antihistamines or beta blockers for situational anxiety. 

Depression treatment also center on SSRIs such as sertraline, fluoxetine, and escitalopram. They are generally effective and better tolerated than older antidepressants. SNRIs like venlafaxine and duloxetine are also frequently prescribed, particularly when patients experience low energy or co-occurring pain.

Some quads use bupropion, which works on dopamine and norepinephrine and may improve motivation and concentration with fewer sexual side effects, and mirtazapine, which can help with insomnia and appetite loss.

No two people will likely have the exact same results from taking a particular antidepressant. Read the fine print, work closely with your doctor, start off with low dosages and when quitting any psych medication, do it slowly.

Birth control choices are individualized based on mobility, risk of blood clots, autonomic dysreflexia risk, and ability to manage the method independently. Long-acting reversible contraceptives are often recommended because they are highly effective and require little daily management; these include hormonal intrauterine devices (IUDs) as well as the subdermal implant etonogestrel implant.

Progestin-only methods (such as the implant or progestin-only pill) are often preferred over combined estrogen-containing contraceptives in women with limited mobility because estrogen can increase the risk of blood clots. Injectable contraception like medroxyprogesterone acetate may also be used but can affect bone density, which is already a concern after SCI.