The Role of the Pharmacist in Spinal Cord Injury Care

Spinal cord injury (SCI) patients require a complex level of care.

Pharmacists play an integral role in a patient’s care journey, providing expertise on SCI pain management, secondary complications, avoidance of adverse drug effects and a safe discharge to home.

The power of collaboration

Pharmacists work in partnership with physicians, nurses and other members of the care team to optimize medication therapy for SCI patients. Daily discussions and collaboration take place during rounding related to treatment regimen for SCI patients. This patient-centered interdisciplinary approach helps to manage complications such as spasticity (sudden muscle contractions) or autonomic dysreflexia, a life-threatening condition that occurs in people with a SCI often triggered by a full bladder or bowel.

Physicians and nurses also rely on pharmacists to provide guidance regarding adequate antibiotic recommendations for treatment of urinary tract, pulmonary and skin infections.

Every patient is unique and medication management reflects a patient’s functional ability level. Depending on the extent of the injury, in collaboration with other care team members, pharmacists may choose a course of polypharmacy (the concurrent use of multiple medicines) or alter how medication is delivered to a patient.

“During my conversations with nurses, I can help to minimize functional limitations such as difficulty with medication administrations (e.g. change route or path of administration) and timing of doses,” said Select Medical Pharmacist Lam Nguyen, PharmD, BCPS. “All these actions can impact medication adherence and therapeutic benefit for the patient.”

It is also the responsibility of the pharmacist to obtain comprehensive medication histories, identify and resolve discrepancies and educate patients on their medications.

Pain management

Pain is a significant problem for SCI patients and can come in many forms. 

Following are some of the types of pain:

• Neuropathic pain: Most common type of sensory nerve pain and is often described as a burning or tingling sensation.
• Nociceptive pain: Pain that arises from tissues damaged by trauma, surgery or injury characterized by throbbing, aches or burning.
• Musculoskeletal pain: Pain resulting from straining muscles or from spasticity, where certain muscles contract involuntarily and remain so, even resisting being stretched.
• Visceral pain: Pain that originates from the disorder of internal organs and blood vessels caused by nerve damage, infection, inflammation or blockage. This pain is often described as deep, twisting and gnawing.
• Somatic pain: Pain that originates from the skin or the musculoskeletal system, described as aching, gnawing, throbbing or cramping.

“The key to developing a pain plan is getting the right balance of side effects and therapeutic affect between the agents,” said Select Medical Pharmacist Peter Riebschlager, RPh, BCPS. “Most SCI patients’ challenge is neuropathic, so we aim to optimize the doses of our neuropathic pain medications first before increasing the nociceptive pain agents.”

Secondary complications

SCI patients are often at risk for secondary complications such as infected wounds and urinary tract infections (UTIs) related to bladder dysfunction. In these cases, pharmacists ensure safe and effective treatment, minimize side effects and help combat antibiotic resistance.

For wound infections, pharmacists choose the most appropriate antibiotic for the case as well as the dose based on the patient’s kidney function. They also set the duration of therapy. A long-term antibiotic treatment plan is often necessary if the infection is considered a deep-seated abscess or involves inflammation and damage to the bone tissues.

Avoiding adverse effects

SCI patients often have complex medication regimens, which increases the risk of adverse effects. Pharmacists conduct comprehensive medication reviews to identify and prevent drug-related problems. They screen for issues such as inappropriate prescribing, drug-to-drug interaction, therapeutic duplication, adverse drug reactions and non-adherence.

“Pharmacists will also adjust dosages based on individual factors like age, weight, kidney and liver function, which can be altered in SCI patients to optimize outcome and minimize side effects,” said Nguyen. “We can evaluate and recommend discontinuing unnecessary or high-risk medications, reducing the patient’s pill burden at discharge.”

Transition planning and discharge

Pharmacists are involved in the patient’s care throughout their entire stay at the hospital. On the day of discharge, they meet one-on-one with the patient and their family or caregiver to discuss all medications to help set the stage for a safe, seamless transition to home.

“If there are challenges once they get home, we are always available to help resolve them,” said Riebschlager.

References:

Bilgin Badur N, Winkle MJ, Leslie SW. Autonomic Dysreflexia. [Updated 2025 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482434/

Givler DN, Givler A. Asymptomatic Bacteriuria. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441848/