Quality of Life Studies In addition to paralysis, people with SCI contend with many ongoing injury-related medical issues that have a profound impact on quality of life. Researchers are interested in learning about the mechanisms that cause and influence the various medical complications associated with SCI. With a better understanding, researchers hope to design treatment strategies that are tailored to these complications.
Pain Mechanisms
Chronic neuropathic pain associated with SCI is often difficult to treat and is devastating for the person experiencing it. Finding the cause of and treating chronic pain associated with SCI is a major challenge because each pain syndrome varies and there is insufficient knowledge about the specific mechanisms responsible for each pain type. Basic science researchers hope to uncover the causes of neuropathic pain by examining the neural circuits and chemical transmitters that underlie pain syndromes that follow spinal cord damage. With this knowledge, they hope to design better treatments to alleviate pain. (See Basic Science-Neurophysiology section).
Meanwhile, clinical researchers in the pain research group at The Miami Project are involved in several studies that are important for designing more effective treatment strategies for chronic pain. Our researchers have developed comprehensive verbal and physical evaluation tools that are designed to assess the specific components of pain and the psychosocial impact on quality of life in people with SCI. These studies have provided a basis to refine the diagnosis of pain and are critical for the development of tailored treatment strategies for pain following SCI.
Miami Project research has shown:
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About 59 percent of respondants of a postal survey reported their most disturbing pain started within 6 months of their injury. They describe their pain as “burning” most commonly located on the front of the torso and genitals, and on the buttocks, thighs, legs and feet. These data help to define common patterns of pain in people with SCI and may assist in a better understanding of the mechanisms of pain following SCI. [Abstract]
- Researchers found the most common treatments used for SCI-related pain were massage, opioids, and nonsteroidal anti-inflammatory drugs. Overall, 50% percent of those who received physical therapy type treatments indicated their pain was “considerably reduced” or they were “pain free” while those who took prescription medications reported more intense pain with neuropathic characteristics. The results of this study confirm that prescription medication did not effectively relieve SCI-related pain and points to the need for additional research in treatment strategies that are tailored to various types of pain. [Abstract]
Spasticity
Spasticity, in some form, is experienced by most people with SCI. Although the reason is unknown, people with motor incomplete SCI are more likely to experience severe spasticity than those with complete injuries. In some cases, severe spasticity has an impact on quality of life because it may be associated with pain, it interferes with a person's ability to sleep, or it jeopordizes their safety by increasing their risk for falling.
Miami Project researchers have evaluated various treatments to reduce spasticity. Over the years, they have assisted drug companies in examining the effectiveness of various drugs such as Botox or Tizanidine. [Abstract] Some drugs were shown to be effective to some degree, however, researchers continue to look for better treatments.
Recently, The Miami Project was involved in a multi-center study sponsored by Acorda Therapeutics to study the effectiveness of Fampridine SR, also known as 4-AP. It is believed that 4-AP enhances conduction of nerve impulses in damaged nerves. Initial trials with 4-AP suggest it has a beneficial effect of reducing spasticity. The goal in recent studies was to more clearly delineate the effects of 4-AP on moderate to severe spasticity. Additionally, researchers are interested in its effects on bowel, bladder and sexual functions. For further information about the status and results of 4-AP studies, visit www.acorda.com.
Currently, in conjunction with the VA Center of Excellence on Functional Recovery and SCI, researchers are evaluating the effects of penile vibratory stimulation on spasticity. Anecdotal reports have shown that producing an ejaculation for fertility purposes resulted in a significant decrease in spasticity. Therefore, we are performing a study to assess whether this technique would be useful as a clinical tool for the treatment of spasticity.
Male Fertility Research
For men with SCI, the ability to have erections and ejaculations as well as the quality of their semen affects their fertility. The quality of semen in men after SCI is often impaired, making it difficult to father children naturally.
The goal of the male fertility research program is to characterize fertility in men with SCI and to learn more about factors in SCI that disrupt semen quality. Studies have indicated that the impairments are not caused by factors such as elevated scrotal temperature, infrequent ejaculations, the method of bladder management, or the amount of time since injury. Rather, researchers believe that impaired semen quality may be related to abnormalities in chemical factors within the seminal plasma that may cause the seminal plasma to become toxic to the sperm. It is now thought that the sperm become impaired when they mix with the semen during ejaculation. Researchers are working to develop treatments to reverse the problem of poor sperm motility.
Recent findings show:
Sexual Function
Depending on the level and extent of injury, SCI affects the ability to have erections and orgasms. Recent research findings are providing new information and hope for improving sexual responsiveness. By conducting studies to assess the nervous system's role in sexual function, important information regarding the resulting deficits at various levels of injury is becoming available. With this new knowledge, researchers hope to develop treatments to enhance sexual responsiveness in both men and women.
Currently a number of studies are underway to assess the effects of spinal cord injury on sexual response and to develop new treatment methods to remediate sexual dysfunction. This includes a study of the effect of SCI on sexual arousal and orgasm in males and studies of sexual arousal and orgasm with spinal cord dysfunction secondary to multiple sclerosis. In addition studies are being conductied to determine the effectiveness of sympathetic manipulation and the use of vibratory stimulation versus clitoral vacumn suction for improving sexual responsiveness in women with spinal cord dysfunction.
Miami Project Faculty working in this area of study
Nancy L. Brackett
Alberto Martinez-Arizala
Eva Widerstrom-Noga
Other articles related to:
Pain
Director's Summaries
Measuring Sensation and Treating Neuropathic Pain
Pre-Clinical Treatments for Pain
Assessing Pain Mechanisms
Clinical Patterns of Pain
Cultivating Chromaffin Cells
Basic Studies of Adrenal Cells
Clinical Study of Adrenal Cells
Research Reviews
Summer 1997: New Research Takes Aim at the Difficult Problem of Pain
Sexual Function
Director's Summaries
Female Sexual Function
Women's Issues
Fertility
Male Fertility Research Program Home
A Guide and Resource Directory to Male Fertility Following SCI/D
Director's Summaries
Characterizing Mechanisms for Male Infertility
Causes of Male Infertility
Male Fertility Guide
Causes of Male Infertility
Research Reviews
Spring 1995: New Hope for Fatherhood After SCI |
