Pharmacological Management of Fatigue in SCI

Numerous classes of medications (for example, stimulants such as methylphenidate and modafinil, dopaminergic medications such as levodopa, and antidepressants, including selective serotonin reuptake inhibitors, and tricyclic antidepressants) have been studied in other populations with central nervous system disorders and fatigue, such as Parkinson’s disease, stroke, or TBI (Levine & Greenwald 2009). However, we found no studies assessing the effects of these medications and fatigue in people with SCI.

It is possible that there are fewer studies on medications and fatigue in SCI because of the increased risks for undesirable side effects, including additional fatigue, difficulty sleeping, anxiety, and headaches (Asano & Finlayson 2014; Levine & Greenwald 2009). In one retrospective chart review, Lee et al. (2010) found that 52% of participants with SCI had clinical levels of fatigue deemed to have been caused by 41/147 medications that they were taking, often anti-spasticity or analgesic medications. Similarly, Fawkes-Kirby et al. (2008) found that people with SCI taking two or more prescriptions from these categories scored significantly worse on the FSS, indicating higher levels of fatigue. According to Fawkes-Kirby et al. (2008), among the medications that people with SCI commonly take, baclofen, benzodiazepines, opioids, tizanidine, gabapentin, amitriptyline, and nortriptyline may induce feelings of fatigue. In addition, people with SCI have commonly reported fatigue as a side-effect after cannabis use (Nabata et al. 2020); however, the therapeutic use of cannabis in SCI is an emerging area of research.

Currently, there are only two medications that have been studied in people with SCI for fatigue improvement purposes: cannabis medicinal extracts (CME) and baclofen.