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    Spasm intensity increased, why?

    I have a C5/6 SCI since 1981. Up until approximately 1 year ago, I managed my spasms with Baclofen, 120 mg/day. I experienced some medical issues, elbow surgery & a pressure sore that caused me to start using a power w/c and spend the better part of 3 months in the bed. Prior to these medical issues I used a manual wheelchair & was working 50+ hours/week. During this time of limited activity the intensity of spasms increased greatly; to the point that I can hardly sleep and sitting up in a wheelchair is dangerous at times. It seems my spasms are worse in the power w/c than my manual w/c.
    I had a few months of relief when I started taking Gabpentin along with Baclofen. The Gabapentin has ceased to help. I was taking 2700 mg/day. I tried Botox- total waste of time & $.
    I have tried numerous other meds- Flexeril, Diazepam, Zanaflex, etc with little to no relief.
    The neurologist is indicating a baclofen pump may be necessary but I am reluctant.
    Why did the spasms intensity spike up so suddenly? After 25+ years of full time employment I resigned from my job and now I am at home constantly fighting these spasms.
    Before anyone asks, I do not have access to medical/recreational cannabis in my state. I do get temporary relief when I partake.
    Any other ideas other than a move to FL?

    #2
    so you went back to work/resumed regular activities after your medical issues? My spazzies go nuts when I don't exercise like I should. Now that you use a powerchair is there any way to do the same amount of physical activity as you once did? I really like the skiErg (cable rowing machine) for some exercise if wheeling isn't an option.

    Obviously you've been at this cripple game a lot longer than me, but I thought I'd throw my hat in the ring.

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      #3
      My only contribution is essentially the same as tooley's. When I even begin seriously moving around late in the day my spasticity is worse. Both pain and spasms are much worse when I cannot move around much. If that does not help slowly restore you, have you looked carefully for other medical issues that may be lurking? I'm very sorry you had to quit work.

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        #4
        Similar issue with me. Turned out it was kidney stones. Other culprits are skin, nails, and bowels stimulating the nervous system as a signal to do something about it. We can't feel it so we don't do anything about it. If the stimuli doesn't go away, it will probably get worse. The result is spasms. That's your body shouting out to you.

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          #5
          The spasms are either the result of one of your medical issues/surgeries you mentioned or another problem unknown. You may consider a thorough exam; kidney/bladder US or abdominal CT scan. Did you have bone involvement when you had the wounds? A surgical flap? We’re you treated for infections?

          pbr
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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            #6
            Thanks for all of the feedback. Next week I am scheduled for urodynamic testing & a renal ultrasound- it has been several years. I had an MRI over a year ago as tx for my elbow and never experienced any infection nor bone involvement. Exercise & movement do seem to help. I am pushing my manual w/c more frequently & I have an old BowFlex Verstrainer that I am getting re-acquainted with; however, I lost all of my stamina so it is slow. 37+ years of pushing & my shoulders feel it.
            I am inclined to suspect the kidney stones theory.
            Thanks again.

            Comment


              #7
              Originally posted by 1981quad View Post
              Thanks for all of the feedback. Next week I am scheduled for urodynamic testing & a renal ultrasound- it has been several years. I had an MRI over a year ago as tx for my elbow and never experienced any infection nor bone involvement. Exercise & movement do seem to help. I am pushing my manual w/c more frequently & I have an old BowFlex Verstrainer that I am getting re-acquainted with; however, I lost all of my stamina so it is slow. 37+ years of pushing & my shoulders feel it.
              I am inclined to suspect the kidney stones theory.
              Thanks again.
              Keep us informed, old guy

              From an old woman

              Comment


                #8
                Throughout my SCI life whenever my spasms got really bad, it was an indicator that something was wrong.

                Trying to figure out what is wrong is the difficult part, but start with the usual suspects bladder, bowel, skin, bones.

                Comment


                  #9
                  I hope your description of taking 2700 mg. of gabapentin daily is a typo! That is 100X the safe dose. Gabapentin is a decent drug for neuropathic pain in SCI for some, but doesn't help much with spasticity. Similarly, Flexoril is not appropriate for central nervous system spasticity (it is designed for muscle spasm due to peripheral nerve or muscle injury). Have you also tried dantrolene sodium (Dantrium)? Valium? Most studies with baclofen (which has a suggested maximum dose of 80 mg. daily) show that the effectiveness is not increased by exceeding that dose, but side effects and complications of use can significantly increase.

                  Have you had a recent seating evaluation? Increased spasticity when in your chair may be an indicator of a seating situation (cushion, back, etc.) that needs correction.

                  Suddenly increased spasms and spasticity, like AD, are signs that there is something going on wrong with your body. The problem is that this is a non-specific sign; it may take a systematic exploration of possible causes. This can include everything from urinary stones, stomach ulcers, or gall bladder problems, to skin breakdown, broken bones, HO, or even opiate withdrawal.

                  I agree with pbr that you should have a comprehensive exam by your PCP to rule out problems that may be causing this rather than just trying to treat the spasticity/spasms. Conditions causing them to increase can be life threatening, and due to your SCI/D, you may not have normal symptoms for these problems.

                  Spasticity/spasms is also commonly increased with aging, and, can occur with an enlarging syrinx, so these should be considered after ruling out any of the problems above.

                  A baclofen pump may be something to consider. You may want to read other members comments here about getting one, and the impact it had on their spasticity. You would need to have a test intrathecal injection to see if it may be an option for you.

                  (KLD)
                  Last edited by SCI-Nurse; 28 May 2019, 11:47 AM.
                  The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                  Comment


                    #10
                    T-10 Para post 5 years. I had sever spasms also it consumed my every day life. Got to where I couldn't drive without having an accident. A medtronic baclofen pump changed my life controlled the spasms all together once they got the dosage right. It also has a dual function administers pain medicine to my spine. I am on my second pump now and has changed my life for the better.

                    Comment


                      #11
                      Do you get range of motion on your legs?

                      I'm also a C-6 quad, also been taking 120 mg of Baclofen a day for a long time, and was also injured in the 80's. The older i've gotten though, any day that i don't get range of motion on my legs in the morning, i'm stiff the whole rest of the day and for some reason my feet will hurt even more than they typically do.

                      Comment


                        #12
                        A lot of work to track down the cause

                        When in rehab '82 went up and over the rails of the hospital bed and was hanging by my elbow. Next morning there was a new pill in my cup, 5 mg of Valium.

                        These severe spasms kept throwing me out of bed and shooting me over the back of my wheelchair like a rocket or slamming my head on the headboard. Went up to 60 mg of Valium a day and then back to 30. The Valium was never controlled my severe spasticity.

                        However, it did help to alleviate the pain caused by the muscles in my lower back firing when stressed. If there is not not adequate serum level can keep the muscles firing for days, putting me in incredible pain and wiping me out.

                        So now after 37 years, no longer have the strength because of the atrophy to throw me out of bed, but still get the body slams.

                        Remember my spasms use to go away completely for days after going scuba diving. Imagine that every muscle was totally relaxed floating there for a couple hours. :-)

                        Best of luck, though do not understand what Florida has to do with your spasms, unless you want to go scuba diving. Moved here in 75 and it only gets hotter.

                        Comment


                          #13
                          Thanks again for the feedback.

                          To Cris- my mention of FL was intended to refer back to my comment that cannabis does temporarily relieve my spasms & FL's medical program. I can relate to the 'body slams' that you describe.

                          I was not able to complete the Urodynamics testing because I was experiencing too many spasms. The facility did not have an accessible examination table which contributed to the inability to successfully complete the procedure. I am in the middle of educated the provider on that subject. The renal ultrasound was fairly benign, no kidney stones.

                          Recently, I went to PT for an eval on my spasms. After 2 visits I was informed that the cause of the spasms are neurological and not muscular. Range of motion rarely helps beyond some immediate relief which quickly returns to spasms.

                          I had surgery on a syrinx back in 96 so yet another issue to consider. I was in a bad vehicle accident back in 1991 and broke my right hip among other body parts. Since my recovery from that accident I do not sit straight. It seems like my right leg is shorter that my left leg. Spasms may come from scoliosis or a bulging disc.

                          I appreciate the ideas/suggestions.

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