Medication use is associated with fatigue in a sample of community-living individuals who have a spinal cord injury: a chart review

Abstract

Objectives: To investigate the relationship between medications known to cause fatigue in spinal cord injury (SCI) and fatigue severity and to describe the pattern of prescription of these medications. Results: Fifty-two percent of the subjects had clinically relevant fatigue. As a group, the subjects were taking 147 different medications; 41/147 medications were identified as causing fatigue. The two most commonly prescribed categories of medications were antispasticity medications (75 subjects) and analgesic medications (61 subjects). Although several variables were found to contribute to the FSS scores including the use of fatigue-causing medications, the presence of pain (7.6% of variance) and the use of fatigue-causing analgesics (4.2% of variance) explained the most variance in the scores. Conclusion: Fatigue is prevalent in outpatients with SCI. Fatigue-causing medications contribute to a higher FSS score. Clinicians treating persons with SCI should be aware that fatigue is a common and significant problem. Clinicians should be aware that fatigue may be exacerbated by the use of medication and should enquire about the effects of medication on fatigue when assessing and prescribing new medications.

Fatigue in persons who have lived with spinal cord injury for >20 years

“…According to our results, the daily intake of a number of antihypertensives, analgesics and medications for spasticity, probably affects PF, but to a small degree the mental dimensions of fatigue in persons with longstanding SCI. The findings support Lee et al 10 who also found that usage of a number of analgesics was statistically significantly contributing to higher fatigue scores as measured with the Fatigue Severity Scale. However, the Fatigue Severity Scale (unidimensional scale) does not distinguish mental and physical dimensions of fatigue.…”

“…In previous studies, some of the above mentioned variables have shown relationships to fatigue. [8][9][10] As previously mentioned, the variability of findings among studies may be related to methodological differences, and need further clarification.…”

“…24 These variables were selected based on judgement and previous research. [8][9][10] Collinearity problems were indicated if the variance inflation factor for any covariate exceeded five, and by Spearman correlations. …”

“…[8][9][10][11] It is known that depression is common after SCI, and previous reports have documented a relationship between depression and fatigue. 2,9 There is however a challenge to determine whether depression is a contributor to fatigue or vice versa.…”

Medication profile and polypharmacy in adults with pediatric-onset spinal cord injury

“…4 Such medications can cause adverse effects on their own with risk of adverse reactions increasing when combined with other medications, potentially leading to interference with rehabilitative efforts and daily activities. Recent research reports medications for pain and spasticity to be associated with increased risk of fatigue and falls, [5][6][7] whereas psychotropic medications have been associated with reduced life expectancy in individuals with SCI. 8 Predicting the possibility of adverse drug effects is more challenging in SCI because drug pharmacokinetics can be altered following the injury and the degree of alteration can vary depending on the level and severity of SCI.…”