DYSREFLEXIA/HYPERREFLEXIA
Autonomic Dysreflexia (sometimes spelled "disreflexia"), also known as Autonomic Hyperreflexia, as you may well know, is the autonomic nervous system's response to pain stimuli below the level of injury, in people with damaged spinal cords. If unchecked, or with enough stimulus, dysreflexia can lead to heart attack, stroke, and death. In SCI folks (T-10 and above), the autonomic nervous system response to pain is an increase in blood pressure. One can generally sense the onset of even mild dysreflexia by, what can be described as, a tingling sensation, primarily in the head. As the pain stimulus increases, so does the autonomic response, and consequently, one’s blood pressure. Symptoms elevate from a mild tingling sensation, to stronger tingling sensation and/or sweating (primarily from the head), increasingly reddening face, then minor headache, to more severe headache, and eventually, severe throbbing or pounding headache. On at least one occasion, I had a blood pressure of 320/280. It wasn't much fun. I thought my head was going to explode. Once we relieved the pain, my blood-pressure returned to normal. But I was lucky I didn't stroke out or die. Residual headache, at least for a while, can be expected from that kind of spike in blood pressure.
In the event that the pain stimulus cannot be located, or removed (physically or medically) pharmacologic treatment may be used to stem dysreflexia. I've never tried "immediate-release nifedipine," so I don't know firsthand whether it works. But I've read things from SCI folks who report it is an effective arrester of spiking blood pressure. Apparently, there has also been some success with captopril. For some literature on drug therapy and dysreflexia, click here, here, and here .
The problem is, drug therapy does not remove the cause of pain. So your body may suffer other harms, for which the autonomic nervous system response of increased blood pressure was intended to be a signal. For instance, you may have a full bladder, a kidney stone, an impacted bowel, pressure on a bony prominence, an infection, a broken bone, or some other source of pain you can't feel. Pain would normally signal something needs to be done. Dysreflexia acts as a substitute signal. Drug therapy may be appropriate to calm acute dysreflexia, but you still need to find the source of pain and address it, before it results in long-term damage.
I've read that people consider dysreflexia to be a highly dangerous condition. Left unchecked, or on the greater end of the spectrum, I would agree that increased blood pressure can be very dangerous. But, everyday, garden-variety, mild dysreflexia has not ever been a problem, at least for me. It serves as a friendly warning of some pain stimulus. When I experience a mild dysreflexia my first response is to ensure my bladder is draining properly. Next, it may signal some bowel issue. I experience some dysreflexia regularly (with every bowel program). I feel a fairly strong tingle, and I sweat rather profusely, but it is not painful, or even very uncomfortable. I have grown used to it.
Perhaps it is a danger to experience the increased blood pressure on a fairly regular basis (twice a week). But, it may also make my body more resilient. Perhaps the heart work-out and stretching of the veins, vessels, and capillaries is a good thing ... strengthening my cardiovascular system. But then again, it may be setting me up for a big blow-out. I don't know. But I don't see any realistic way around it. So I'm hoping the old adage, "what doesn't kill you makes you stronger" is true. I tend to think it is. Talk to your doctor, try to determine what's right for you.
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