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Thread: Narcotics in Acute SCI?

  1. #1

    Narcotics in Acute SCI?

    Dr. Young,

    A paramedic friend called me yesterday and told me about a possible new SCI earlier in the day [diving] and was wondering if there was any research into administering narcotics like morphine acutely after injury. He explained that morphine dilates the blood vessels and the first/only thing I thought of was getting the body cold to slow down blood flow and the metabolic process to slow the secondary damage.

    Is there anything you can think of? Nothing interesting showed up for me at PubMed, although I may have been searching for the wrong thing.

    [note: he didn't call at the scene of the accident, he was thinking about it later on]

    -Steven

  2. #2
    Stephen, there is much evidence that narcotics in fact may be harmful in the acute spinal cord injury situation. In the 1980's, I spent much time investigating the effects of naloxone (a specific opiate receptor antagonist) and its positive effects on the injury. Naloxone significantly increases blood flow in the acutely injured spinal cord. Wise.

  3. #3
    Steven, search PubMed for "cooling" or "hypothermia" and SCI. There's some research indicating that decreasing body temperature can have a positive effect on reducing the extent of damage in acute SCI.

  4. #4
    Super Moderator Sue Pendleton's Avatar
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    Steven, I read an article years ago that studied the effects of narcotics, especially sedating ones, in CVAs (regular strokes). The main conclusion was that any sedating drug tended to reduce amount and speed of recovery. The smallest amount I remember was a low dose of diazepam to avoid seizures.

    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

  5. #5
    Thanks for the replies. I assumed it would be bad, but I wanted to double-check with others.

    Thanks again!

    -Steven

  6. #6
    On the other hand, I would not want people to think that it is inappropriate to provide patients with acute spinal cord injury with appropriate interventions for pain, including opiates.

    Too many people with acute injuries are undermedicated for their pain in hospitals in the USA, leading to unnecessary suffering.

    (KLD)

  7. #7
    I agree with KLD. My comments were not meant to indicate that narcotics are bad for the spinal cord, only to point out that there was once a theory that suggested that naloxone (an opiate receptor antagonist) is beneficial when given shortly after injury. This does not mean that narcotics are bad at all times after injury. Wise.

  8. #8
    Don't worry, I was just asking about very acute time frames -- like at the scene of the accident.

    -Steven

  9. #9
    Super Moderator Sue Pendleton's Avatar
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    Dumb question #1,987. Since my paralysis was non-traumatic, does a broken neck hurt? I mean if there are no other injuries above the level of major spinal cord injury.

    CVAs tend to cause pain in the effected shoulder/arm and it spreads into the non-effected side. There is also the damage in the brain that caused the stroke that can cause pain in its connecting lower body part, cause seizures, slurred speech, dementia symptoms, etc. So I understand medicating those patients. But I had only very temporary, but BIG TIME, pain in my elbows when the artery to my spine at the C4-5 level became blocked and caused my SCI. That area covers the biceps so the pain makes sense. I doubt it lasted more than 10 minutes tops. Other than neck pain from spinal taps I didn't have any other pain in the first 6 to 8 weeks. Oops, take that back. I was given IV valium right before getting my lungs suctioned while in the ICU.

    Was my experience normal or does a traumatic SCI cause acute to subacute pain?

    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

  10. #10
    Banned Faye's Avatar
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    Sue, you are lucky you were only given valium once. In rat studies more than a decade ago, it was found that rats who were given valium had no motor recovery at all, but the controle group with similar injuries who did not get valium did have some motor recovery.
    Unfortunately I did not read about this study until after Jason had been given valium for several months, to reduce the rigidity/spasticity after he became quadriplegic from a blocked artery in his brainstem.
    Too often sedatives are given for the convenience of the caregivers with detrimental effects to the patient's recovery potential.

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