Article (Scientific journals)
Evaluation of the effect of analgesic treatment on signs of nociception-related behaviors during physiotherapy in patients with disorders of consciousness: a pilot crossover randomized controlled trial
Bonin, Estelle; Binda Fossati, Mariachiara Luisella; Filippini, Maddalena et al.
2022In Pain
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Keywords :
Consciousness disorders; Pain management; Nociception Coma Scale-Revised; Physical therapy; Minimally conscious state; Unresponsive wakefulness syndrome/Vegetative state; Randomized controlled trial
Abstract :
[en] Neuro-orthopedic disorders are common in patients with disorders of consciousness (DOC) and can lead to potential pain. However, the patients' inability to communicate makes pain detection and management very challenging for clinicians. In this crossover randomized double-blind placebo-controlled study, we investigated the effects of an analgesic treatment on the presence of nociception-related behaviors. At baseline, the Nociception Coma Scale-Revised (NCS-R) was performed in 3 conditions: a non-noxious stimulation, a noxious stimulation, and during a physiotherapy session. Patients with a NCS-R total score during physiotherapy equal or above the score observed after the noxious stimulation could participate to the clinical trial, as well as patients with a score above 5. They received an analgesic treatment and a placebo on 2 consecutive days in a randomized order followed by an assessment with the NCS-R. Of the 18 patients, 15 displayed signs of potential pain during physiotherapy. Patients showed higher NCS-R scores during physiotherapy compared with the other conditions, suggesting that mobilizations were potentially painful. Of these 15 patients, 10 met the criteria to participate in the placebo-controlled trial. We did not find any effect of analgesic treatment on the NCS-R scores. This study highlights that physiotherapy may be potentially painful for patients with DOC, while analgesic treatments did not reduced NCS-R scores. Therefore, careful monitoring with appropriate assessment and treatment before and during mobilization should become a priority in clinical settings. Future studies should focus on the development of assessment tools sensitive to analgesic dosage to manage pain in DOC.
Research center :
Giga Consciousness-Coma Science Group ; CHU de Liège - Centre du Cerveau²
Disciplines :
Neurosciences & behavior
Author, co-author :
Bonin, Estelle  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Binda Fossati, Mariachiara Luisella 
Filippini, Maddalena
Bornheim, Stephen ;  Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie générale et réadaptation
Lejeune, Nicolas  
O'Brien, Anthony
Bodart, Olivier  ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
Laureys, Steven  ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Thibaut, Aurore ;  Université de Liège - ULiège > GIGA Consciousness - Coma Science Group
Chatelle, Camille 
Language :
English
Title :
Evaluation of the effect of analgesic treatment on signs of nociception-related behaviors during physiotherapy in patients with disorders of consciousness: a pilot crossover randomized controlled trial
Publication date :
2022
Journal title :
Pain
ISSN :
0304-3959
eISSN :
1872-6623
Publisher :
Elsevier, Netherlands
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
F.R.S.-FNRS - Fonds de la Recherche Scientifique [BE]
FRB - Fondation Roi Baudouin [BE]
Available on ORBi :
since 03 October 2021

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