How Pain Can Kill – the Autonomic Nervous System Can Create Havoc in Response to Pain Stimulus in Those with Spinal Cord Injuries

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PushLiving.com usually focuses on positive Lifestyle, Travel and Inclusion features. However, we want to take a moment now to educate our readers regarding how all three of these and your very life could be taken as a result of one sudden medical crisis. You could go from being perfectly fine to your body literally turning on you and creating a chain reaction that could lead to stroke or death. If you have a T-6 or above spinal cord injury or disorder, or you know someone who does, please take a moment to read and share this important, potentially lifesaving, information.

It can come on slowly… a headache begins to form and gets worse with each passing minute. Your neck may hurt as well. You may have goose pimples, sweating, with or without the headache. You have no idea what is wrong. Or, even more terrifying, it may come on suddenly; an extreme pounding headache out of nowhere, rendering you incapable of seeing straight and you may feel nauseas. You panic as you have no idea what is wrong; you are scared.

These are symptoms of Autonomic Dysreflexia – AD and can lead to a stroke or death in quick order if not managed – and quickly.

Those who have an injury above T-6 probably already have experienced some slight AD with pain stimuli below the injury level, such as sweating and chills when you have a full bladder, skin irritation, or stomach/bowel issues. You deal with it as it comes, but what if it comes on fast and without notice and is very intense? What do you do? What if you are alone/driving?

Here are the steps you need to take and the information that can literally save your life. 

#1 Read about AD and print out the cards/info below and educate those who are close to you.

#2 Get an automatic blood pressure cuff and take your BP to determine what your normal everyday blood pressure is so you can compare it to AD episodes. Pay attention to your BP readings while at your medical visits. Get to know your body. It is VERY important that you do not allow anyone to tell you what your “normal BP reading” should be. For example: ”Oh 140/70 is not dangerous,” when your normal BP is usually under 100/50. Your brain will react to a major change outside normal levels, and this is different for everyone.  A BP reading of 140/90, for example, can be excruciatingly painful and dangerous, causing blurred vision, headaches and lead to stroke for a person who is normally 90/40!

Know your normal range BP. VERY IMPORTANT: “An individual with SCI above T6 often has a normal systolic blood pressure in the 90–110 mm Hg range. A blood pressure reading of 20 mm to 40mm Hg above baseline in adults may be a sign of autonomic dysreflexia.”

#3 Have a discussion with your doctor and get them to write prescriptions for medications that you will carry with you at ALL times to ward off the resulting high blood pressure and dangerous, intense headaches that can come with AD. This will treat the symptoms caused by an AD attack until you can find the CAUSE of the pain stimuli that has created the serious AD symptoms, which are high BP and resulting headache.

Medications that can help alleviate the dangerous onset of symptoms caused by Autonomic Dysreflexia:

Nitro Paste – You will squeeze one inch out onto the dose measuring applicator provided and place it on your chest. This will lower blood pressure. It can also create more of a headache as it dilates your blood vessels in your brain.

You can use this pill to counteract headaches from AD and Nitro.

Fioricet® 
(butalbital, acetaminophen, and caffeine) Tablet

Your doctor may prescribe these or other meds in the case of an emergent AD attack or to treat milder AD symptoms. The bottom line is: make sure you have a plan as you do not want your blood pressure to remain high long enough to cause serious damage, such as a stroke or death.

This little print out about AD (Autonomic card) may save your life.

http://www.christopherreeve.org/atf/cf/%7B173bca02-3665-49ab-9378-be009c58a5d3%7D/AUTONOMIC%20DYSREFLEXIA%205-10.PDF

Here is the link to order a laminated card to carry in your wallet.

http://bit.ly/1hkCofT

Image Courtesy of Photoability.net

Image Courtesy of Photoability.net

Give these cards to any medical professionals that treat you, as most will not be familiar with the condition.  Many medical professionals will continue to treat you as they would any other non neuro patient. They will treat the headache and BP with meds, but they will not understand that AD is the issue and that it must be resolved. Be your own strong advocate. Insist on tests being done to rule out any possible pain stimuli that is causing Autonomic Dysreflexia symptoms. You are not just like any other patient and you must be treated differently.

Here is a good explanation of what AD is and how it can be caused: 

What happens during an episode of AD?

Autonomic dysreflexia means an over-activity of the autonomic nervous system – the part of the system that controls things you don’t have to think about, such as heart rate, breathing, digestion, etc. AD can occur when an irritating stimulus is introduced to the body below the level of injury.

The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked at the level of injury.

Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure. Nerve receptors in the heart and blood vessels detect this rise in blood pressure and send a message to the brain.

The brain then sends a message to the heart, causing the heartbeat to slow down and the blood vessels above the level of injury to dilate. However, the brain cannot send messages below the level of injury, due to the spinal cord lesion, and therefore the blood pressure cannot be regulated.

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

Potentially useful agents include: Nitroglycerine, Clonidine, Hydralazine, Minipress, Catapres.

Deborah Davis

Deborah is a Speaker, Disability Inclusion Consultant, Entrepreneur, Writer and Business Owner of Wheelchair Lifestyle Enterprise Push Living Inc.

She was a Former Dancer, Accident Survivor (C 6-7 Spinal Cord Injury resulting in incomplete Quadriplegia 1985), College grad (BBA Finance 1991 U of Miami), with a background in Sales and Marketing and Non Profit Development and Management.

She is now embarked on new path creating a market for Disability Inclusive Stock Images with the creation of PUSHlivingPhotos.com and publishing an online enterprise: PushLiving.com. The mission is to create Inclusion for people with disabilities through stock images for advertising, marketing and editorial uses, providing accessible properties for travel, swap or purchase, publishing an online magazine for improved health and well-being, providing information and opportunities for Accessible Travel, and operating an online store with products that improve lives.

She is most passionate about building a network of people with disabilities who are empowering, supporting and creating a more inclusive world. Personally, she is a mother of two beautiful, wise and exceptionally bright young women, and residing in South Florida.

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