Prevalence of signs of nociception during physiotherapy in patient with disorders of consciousness.

Patients with disorders of consciousness (DOC) may suffer from neuro-orthopaedics disorders that can lead to potential pain during physiotherapy (PT). These patients are unable to communicate it is therefore a real challenge for clinicians to assess pain and adapt treatment. This randomized double-blind placebo-controlled study aimed to investigate the prevalence of signs of nociception during PT and their changes in relation to a pain-killer.
During baseline (D0), pain responsiveness was assessed using the NCS-R (Nociception Coma Scale-Revised): at rest; during a tactile stimulation (TS); during a nociceptive stimulation (NS); and during PT. Then, patient with signs of potential pain during PT was assessed during a placebo and a pain-killer condition (D1 and D2).
Our results show that most DOC patients present signs of potential pain during PT (14/19; 73.4%), and a few of them already received analgesic treatment before the study (5/14, 35.7%). During baseline, we found significant differences between the NCS-R score during PT than the three others stimulation, suggesting that passive mobilizations are potentially painful for DOC patient. These difference remains during placebo and treatment condition expect with the NS. We do not found an effect of pain-killer on the NCS-R score during PT and NS. This could be explained by the fact that the NCS-R failed to detect the effect of pain-killer or that this effect was not strong enough.
This study point-out that PT may be painful for DOC patients and appropriate assessment and treatment before and during mobilizations should become a priority in clinical setting.