Journal of rehabilitation research and development
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A significant complaint associated with spinal cord injury (SCI) is chronic pain, which includes symptoms such as cutaneous hypersensitivity and spontaneous unevoked pain and is difficult to treat with currently available drugs. One complication with current analgesics is tolerance, a decrease in efficacy with repeated treatment over time. One promising class of pharmacological treatment is cannabinoid (CB) receptor agonists. ⋯ Similarly, the antinociceptive efficacy of WIN to acute noxious heat in uninjured rats diminished over time. These data suggest that the sustained efficacy of a CB receptor agonist for pain could depend on the pain state. Such agonists may hold promise for long-term use in alleviating chronic SCI pain.
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Spinal cord injury (SCI) results in the development of chronic pain syndromes that can persist indefinitely and cause reductions in quality of life. Treatment of chronic pain after SCI remains extremely challenging; thus, an important research goal is to determine whether early treatments can attenuate the subsequent development of pain conditions. The current study examined the hypothesis that early administration of the microglial-inhibiting drug minocycline could ameliorate the development of pain after SCI. ⋯ Electrophysiological experiments showed that early minocycline administration attenuated the development of chronic hyperresponsiveness of lumbar dorsal horn neurons. Similarly, behavioral assessment showed that minocycline also resulted in increased pain thresholds. These results suggest that inhibition of early neuroimmune events can have a powerful impact on the development of long-term pain phenomena following SCI and support the conclusion that modulation of microglial signaling may provide a new therapeutic strategy for patients suffering from post-SCI pain.
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The objective of this study was to summarize the evidence on the accuracy of screening tools for predicting falling risk in community-living older adults. This study was designed as a systematic review. Prospective studies of clinical fall risk prediction tools that provided data on the number of participants who sustained falls during follow-up were included. ⋯ Most tools discriminated poorly between fallers and nonfallers. We found that existing studies are methodologically variable and the results are inconsistent. Insufficient evidence exists that any screening instrument is adequate for predicting falls.
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We analyzed healthcare costs and medical conditions for 2,008 veterans with spinal cord injuries and disorders (SCI/Ds) near end of life. The average age at SCI/D onset and/ or occurrence was 42 years and at death was 66 years. ⋯ The average cost was $24,900 in the second year before end of life and reached $61,900 in the final year. Before end of life, costs accelerated during the final year from $3,100 in month 12 to $14,600 in the final month.