ABSTRACT
Background/Objectives: Persons with disorders of consciousness (DoCs) may perceive pain without being able to communicate their discomfort. The Nociception Coma Scale (NCS) and its revised form (NCS-R) have been proposed to assess nociception in persons with DoCs. The main aim of this international multicenter study was to confirm (or not) our preliminary results and compare the NCS-R scores of standard stimulus (NCS-R-SS) to scores of personalized painful stimuli (NCS-R-PS). A secondary aim of the study was to verify possible correlations between the NCS-R-PS and Coma Recovery Scale-Revised (CRS-R) and to estimate convergent validity. Methods: Sixty-one patients with prolonged DoCs (pDoCs) were enrolled from seven European post-acute rehabilitation centers. Responsiveness and pain perception were assessed by CRS-R and NCS-R with standard stimulus (NCS-R-SS) and personalized stimulation (NCS-R-PS). ClinicalTrials.gov Identifier: NCT06012357. Results: our results support our prior findings on the superiority and the validity of the personalized painful stimulus approach in assessment of pain in persons with DoCs in comparison with the standardized pain assessment methodology. Conclusions: A more in-depth and tailored assessment of pain perception in persons with a DoC may lead to better acknowledgment of its presence and by extension an objective foundation for more aggressive and appropriate pain management.
ABSTRACT
Patients with a prolonged disorder of consciousness (DoC) may present with severe spasticity and diffuse pain, which might impair motor output, thus preventing any possible behavioral responsiveness. A 26-year-old man affected by frontoparietal hemorrhage was operated by hematoma evacuation and decompressive craniectomy; coma persisted for 1 month; cranioplasty and ventriculo-peritoneal shunting was performed after 4 months. At admission in rehabilitation, he was diagnosed as vegetative state/unresponsive wakefulness syndrome (VS/UWS). The implantation of intrathecal baclofen (ITB) pump (Medtronic SynchroMed™ II), 14 months after, (60 µg/daily), dramatically improved behavioral responsiveness according to Coma Recovery Scale-Revised (CRS-R) from 6 to 12 (1 month after ITB). Nociception Coma Scale-Revised (NCS-R) also changed from 4 to 8 at the same time points. This case report may be an example of covert cognition that should have been diagnosed as a functional locked-in syndrome or motor-cognitive dissociation, rather than as VS/UWS.
Subject(s)
Baclofen/administration & dosage , Baclofen/therapeutic use , Locked-In Syndrome/complications , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/drug therapy , Adult , Coma/therapy , Decompressive Craniectomy , Hematoma/surgery , Humans , Infusion Pumps, Implantable , Injections, Spinal , Intracranial Arteriovenous Malformations/complications , Intracranial Arteriovenous Malformations/surgery , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/surgery , Male , Muscle Spasticity/etiology , Pain Management/methods , Recovery of Function , Treatment OutcomeABSTRACT
The Coma Recovery Scale-Revised (CRS-R) is the gold standard of responsiveness assessment in patients with disorder of consciousness. The purpose of this study is to search for the efficacy of the caregivers' involvement in the evaluation of responsiveness in these patients. Responsiveness assessment was performed in 15 patients with CRS-R. The CRS-R was administered with and without the emotional stimulation of the primary caregiver at different times. Our preliminary findings seem to suggest that, including also the caregivers during CRS-R assessment, may obtain better responsiveness scoring than that obtained by professionals and might reduce the misdiagnosis rate.
Résultats à l'échelle d'évaluation d'éveil lors d'un coma avec ou sans la stimulation affective de personnes soignantes. L'échelle d'évaluation d'éveil lors d'un coma (Coma Recovery Scale-Revised) demeure la norme de référence en matière d'évaluation de la réactivité de patients aux prises avec des troubles de la conscience. L'objectif de cette étude est d'analyser l'impact de l'implication de personnes soignantes dans l'évaluation de la réactivité de ces patients. Une telle analyse a été effectuée chez quinze patients soumis à l'échelle d'évaluation d'éveil lors d'un coma, et ce, avec ou sans la stimulation affective d'une personne soignante et à différents moments. À cet égard, nos constatations préliminaires semblent indiquer que les scores de réactivité à cette échelle pourraient, en présence de personnes soignantes, dépasser ceux obtenus en compagnie de professionnels et ainsi réduire les taux de diagnostics erronés.