Autonomic Dysreflexia (AD is a potentially life threatening condition that can occur in individuals with a spinal cord injury at the sixth thoracic (T6) vertebrae level and above.
Despite its relatively common occurrence among individuals with spinal cord injury, the use of medications for treatment of this condition has not been well studied. Currently, there is no commonly-accepted standard of care and many healthcare providers, including emergency healthcare providers, are not familiar with AD. Jenn Wahl, the staff development and research coordinator at Craig Hospital, is currently working on an inpatient research study and external research study both focused on management and treatment of AD.
AD is an abnormal response which occurs when the body is experiencing pain or discomfort below the level of the spinal cord injury. Because the pain or discomfort message does not get relayed to the brain due to injury to the spinal cord, the body’s autonomic nervous system responds with overactivity, creating dangerously high blood pressure. If the cause of pain or discomfort is not found and treated immediately, serious complications such as stroke, seizure, organ damage, or potentially even death may occur. Up to 70 or 80 percent of individuals with spinal cord injury T6 and above have experienced one or more instances of AD.
Currently, only clinical consensus/expert opinion supports the use of medications to treat AD, the medication chosen depends upon the provider. Nitro-Bid® has long been Craig’s standard medication treatment option. This topical ointment rapidly lowers blood pressure to a safer level allowing the practitioner time to identify the cause of AD. When Nitro-Bid® is removed, the intervention is stopped, decreasing the risk of extremely low blood pressure. This is important as persons with spinal cord injuries tend to run a lower than average resting blood pressure. It was discovered when developing this inpatient study that other rehabilitation facilities use medications such as beta blockers, which can lower a person’s blood pressure to a dangerous level and cannot be removed from the system like Nitro-Bid® can.
“At Craig Hospital we have used Nitro-Bid® for over twenty years to treat AD and we believe this is the medication of choice to treat it,” says Wahl. “I was surprised when researching medication uses for treatment of AD that other centers did not use this medication.”
Under the direction of Wahl and co-investigators Dr. William Scelza and Susan Charlifue, Ph.D., the study seeks to enroll 200 Craig inpatients. The investigators will compare treatment efficacy of Nitro-Bid® 2% topical ointment based on the location of ointment application, with two comparison treatment groups, one receiving Nitro-Bid® to the forehead area, the other group receiving Nitro-Bid® to the chest area. Through study outcomes, the team will establish preferential placement of Nitro-Bid® and will provided clinical data regarding its use.
“Our goal is to produce literature showing that Nitro-Bid® 2% topical ointment is the medication of choice to treat AD, and will enhance patient outcomes using proper treatment modalities,” says Wahl.
Additionally, Wahl is conducting a study, “Enhancing Knowledge Regarding Autonomic Dysreflexia: A First Responders First Response” as part of her doctoral work. Wahl will study the effects of an educational presentation on the knowledge enhancement for emergency care providers regarding the recognition and treatment of AD.
“Many people with spinal cord injuries who are at risk for AD are able to identify its occurrence, signs and symptoms and potential management, yet emergency responders may not be receptive to patient suggestions,” says Wahl. “Though this study, I hope to enhance knowledge among emergency care personnel regarding AD and its treatment.”