Pharmacological Management of Fatigue in SCI

Numerous classes of medications (stimulants such as methylphenidate and modafinil, dopaminergic medications such as levodopa, 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, none of them have been tested in studies with people with SCI. Instead, there are only two medications which have been studied in people with SCI for fatigue improvement purposes such as cannabis medicinal extracts (CME) and baclofen.

On the other hand, pharmacological interventions could provide a risk for undesirable side effects, such as additional fatigue, difficulty sleeping, anxiety, or headaches (Asano & Finlayson 2014; Levine & Greenwald 2009). In a retrospective chart review, Lee et al. (2010) found that 52% of participants with SCI had clinical levels of fatigue, 41/147 medications that they were taking were identified as fatigue causing, and that the medications were usually anti-spasticity or analgesic medications. Fawkes-Kirby et al. (2008) similarly 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.