A 45-year-old man presents for an annual check-up 5 years after a traumatic T4 complete spinal cord injury (SCI). He reports worsening burning pain in his legs and lower abdomen, rating it 6/10. He also mentions gaining 15 lbs over the last year despite no change in diet. He denies fevers, chills, or acute respiratory symptoms but has a history of recurrent urinary tract infections. Current medications include baclofen and intermittent catheterization supplies. He is a former smoker (quit 5 years ago).