guidelines; locked-in syndrome; pain; quality of life; survey; Clinical Biochemistry
Abstract :
[en] Patients with locked-in syndrome (LIS) may suffer from pain, which can significantly affect their daily life and well-being. In this study, we aim to investigate the presence and the management of pain in LIS patients. Fifty-one participants completed a survey collecting socio-demographic information and detailed reports regarding pain perception and management (type and frequency of pain, daily impact of pain, treatments). Almost half of the LIS patients reported experiencing pain (49%) that affected their quality of life, sleep and cognition. The majority of these patients reported that they did not communicate their pain to clinical staff. Out of the 25 patients reporting pain, 18 (72%) received treatment (60% pharmacological, 12% non-pharmacological) and described the treatment efficacy as 'moderate'. In addition, 14 (56%) patients were willing to try other non-pharmacological treatments, such as hypnosis or meditation. This study provides a comprehensive characterization of pain perception in LIS patients and highlights the lack of guidelines for pain detection and its management. This is especially pertinent given that pain affects diagnoses, by either inducing fatigue or by using pharmacological treatments that modulate the levels of wakefulness and concentration of such patients.
Delsemme, Zoé; Coma Science Group, GIGA-Consciousness, University of Liège, 4000 Liege, Belgium ; Centre du Cerveau2, University Hospital of Liège, 4000 Liege, Belgium
Blandin, Véronique; Association des Locked-in Syndrome (ALIS), 92100 Boulogne-Billancourt, France
Alnagger, Naji ; Université de Liège - ULiège > Département des sciences cliniques
Thibaut, Aurore ; Université de Liège - ULiège > Département des sciences cliniques
LAUREYS, Steven ; Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau² ; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, CIUSS, University Laval, Quebec City, QC G1V 0A6, Canada
VANHAUDENHUYSE, Audrey ✱; Centre Hospitalier Universitaire de Liège - CHU > > Service d'algologie - soins palliatifs
Gosseries, Olivia ✱; Université de Liège - ULiège > Département des sciences cliniques
✱ These authors have contributed equally to this work.
Language :
English
Title :
French Survey on Pain Perception and Management in Patients with Locked-In Syndrome.
Laureys, S.; Pellas, F.; Van Eeckhout, P.; Ghorbel, S.; Schnakers, C.; Perrin, F.; Berré, J.; Faymonville, M.-E.; Pantke, K.-H.; Damas, F.; et al. The Locked-in Syndrome: What Is It like to Be Conscious but Paralyzed and Voiceless? Prog. Brain Res. 2005, 150, 495–611.
Maiser, S.; Kabir, A.; Sabsevitz, D.; Peltier, W. Locked-In Syndrome: Case Report and Discussion of Decisional Capacity. J. Pain Symptom Manag. 2016, 51, 789–793. https://doi.org/10.1016/j.jpainsymman.2015.10.021.
León-Carrión, J.; Van Eeckhout, P.; Domínguez-Morales, M.d.R.; Pérez-Santamaría, F.J. Survey: The Locked-in Syndrome: A Syndrome Looking for a Therapy. Brain Inj. 2002, 16, 571–582. https://doi.org/10.1080/02699050110119781.
Demertzi, A.; Racine, E.; Bruno, M.-A.; Ledoux, D.; Gosseries, O.; Vanhaudenhuyse, A.; Thonnard, M.; Soddu, A.; Moonen, G.; Laureys, S. Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue. Neuroethics 2013, 6, 37–50. https://doi.org/10.1007/s12152-011-9149-x.
Laureys, S.; Celesia, G.G.; Cohadon, F.; Lavrijsen, J.; León-Carrión, J.; Sannita, W.G.; Sazbon, L.; Schmutzhard, E.; von Wild, K.R.; Zeman, A.; et al. Unresponsive Wakefulness Syndrome: A New Name for the Vegetative State or Apallic Syndrome. BMC Med. 2010, 8, 68. https://doi.org/10.1186/1741-7015-8-68.
Gallo, U.E.; Fontanarosa, P.B. Locked-in Syndrome: Report of a Case. Am. J. Emerg. Med. 1989, 7, 581–583. https://doi.org/10.1016/0735-6757(89)90278-7.
Schnakers, C.; Majerus, S.; Laureys, S. Diagnostic et évaluation des états de conscience altérée. Diagnosis and investigation of altered states of consciousness. Reanimation 2004, 13, 368–375. https://doi.org/10.1016/J.REAURG.2004.03.019.
León-Carrión, J.; van Eeckhout, P.; Domínguez-Morales, M.d.R. Review of Subject: The Locked-in Syndrome: A Syndrome Looking for a Therapy. Brain Inj. 2002, 16, 555–569. https://doi.org/10.1080/02699050110119466.
Michaelides, A.; Zis, P. Depression, Anxiety and Acute Pain: Links and Management Challenges. Postgrad. Med. 2019, 131, 438– 444. https://doi.org/10.1080/00325481.2019.1663705.
Turk, D.C.; Wilson, H.D.; Cahana, A. Treatment of Chronic Non-Cancer Pain. Lancet 2011, 377, 2226–2235. https://doi.org/10.1016/S0140-6736(11)60402-9.
Bouhassira, D. Neuropathic Pain: Definition, Assessment and Epidemiology. Rev. Neurol. 2019, 175, 16–25. https://doi.org/10.1016/j.neurol.2018.09.016.
Pistoia, F.; Sacco, S.; Sarà, M.; Franceschini, M.; Carolei, A. Intrathecal Baclofen: Effects on Spasticity, Pain, and Consciousness in Disorders of Consciousness and Locked-in Syndrome. Curr. Pain Headache Rep. 2015, 19, 466. https://doi.org/10.1007/s11916-014-0466-8.
Boly, M.; Faymonville, M.-E.; Schnakers, C.; Peigneux, P.; Lambermont, B.; Phillips, C.; Lancellotti, P.; Luxen, A.; Lamy, M.; Moonen, G.; et al. Perception of Pain in the Minimally Conscious State with PET Activation: An Observational Study. Lancet Neurol. 2008, 7, 1013–1020. https://doi.org/10.1016/S1474-4422(08)70219-9.
Laureys, S.; Faymonville, M.E.; Peigneux, P.; Damas, P.; Lambermont, B.; Del Fiore, G.; Degueldre, C.; Aerts, J.; Luxen, A.; Franck, G.; et al. Cortical Processing of Noxious Somatosensory Stimuli in the Persistent Vegetative State. NeuroImage 2002, 17, 732–741. https://doi.org/10.1006/nimg.2002.1236.
Calabrò, R.S.; Naro, A.; Manuli, A.; Leo, A.; De Luca, R.; Lo Buono, V.; Russo, M.; Bramanti, A.; Bramanti, P. Pain Perception in Patients with Chronic Disorders of Consciousness: What Can Limbic System Tell Us?. Clin. Neurophysiol. 2017, 128, 454–462. https://doi.org/10.1016/j.clinph.2016.12.011.
Bruno, M.-A.; Bernheim, J.L.; Ledoux, D.; Pellas, F.; Demertzi, A.; Laureys, S. A Survey on Self-Assessed Well-Being in a Cohort of Chronic Locked-in Syndrome Patients: Happy Majority, Miserable Minority. BMJ Open 2011, 1, e000039. https://doi.org/10.1136/bmjopen-2010-000039.
Bergés, I.-M.; Ottenbacher, K.J.; Kuo, Y.-F.; Smith, P.M.; Smith, D.; Ostir, G.V. Satisfaction With Quality of Life Poststroke: Effect of Sex Differences in Pain Response. Arch. Phys. Med. Rehabil. 2007, 88, 413–417. https://doi.org/10.1016/j.apmr.2006.12.022.
Skevington, S.M. Investigating the Relationship between Pain and Discomfort and Quality of Life, Using the WHOQOL. Pain 1998, 76, 395–406. https://doi.org/10.1016/S0304-3959(98)00072-4.
Staud, R.; Rodriguez, M.E. Mechanisms of Disease: Pain in Fibromyalgia Syndrome. Nat. Rev. Rheumatol. 2006, 2, 90–98. https://doi.org/10.1038/ncprheum0091.
Rousseau, M.-C.; Baumstarck, K.; Alessandrini, M.; Blandin, V.; Billette de Villemeur, T.; Auquier, P. Quality of Life in Patients with Locked-in Syndrome: Evolution over a 6-Year Period. Orphanet. J. Rare Dis. 2015, 10. https://doi.org/10.1186/s13023-015-0304-z.
Bouhassira, D.; Attal, N.; Alchaar, H.; Boureau, F.; Brochet, B.; Bruxelle, J.; Cunin, G.; Fermanian, J.; Ginies, P.; Grun-Overdyking, A.; et al. Comparison of Pain Syndromes Associated with Nervous or Somatic Lesions and Development of a New Neuropathic Pain Diagnostic Questionnaire (DN4). Pain 2005, 114, 29–36. https://doi.org/10.1016/j.pain.2004.12.010.
Ventafridda, V.; Saita, L.; Ripamonti, C.; De Conno, F. WHO Guidelines for the Use of Analgesics in Cancer Pain. Int. J. Tissue React. 1985, 7, 93–96.
Hamani, C.; Fonoff, E.T.; Parravano, D.C.; Silva, V.A.; Galhardoni, R.; Monaco, B.; Navarro, J.; Yeng, L.T.; Teixeira, M.J.; Ciampi de Andrade, D. Motor Cortex Stimulation for Chronic Neuropathic Pain: Results of a Double-Blind Randomized Study. Brain 2021, 144, 2994–3004. https://doi.org/10.1093/brain/awab189.
Annen, J.; Laureys, S.; Gosseries, O. Brain-Computer Interfaces for Consciousness Assessment and Communication in Severely Brain-Injured Patients. Handb. Clin. Neurol. 2020, 168, 137–152.
O’Brien, E.M.; Waxenberg, L.B.; Gremillion, H.A.; Robinson, M.E. Intraindividual Variability in Daily Sleep and Pain Ratings Among Chronic Pain Patients: Bidirectional Association and the Role of Negative Mood. Clin. J. Pain 2011, 27, 9.
Akınoğlu, B.; Aytül Çakci, F. Role of Physiotherapy and Rehabilitation with Cooperation of Family in Locked-in Syndrome: Four-Year Follow-up of a CaseE. Turk. J. Physiother. Rehabil. 2018, 29, 95–99. https://doi.org/10.21653/tfrd.421951.
Vanhaudenhuyse, A.; Nyssen, A.-S.; Faymonville, M.-E. Recent Insight on How the Neuroscientific Approach Helps Clinicians. OBM ICM 2020, 5, 1–20. https://doi.org/10.21926/obm.icm.2002028.
Grant, J.A.; Courtemanche, J.; Rainville, P. A Non-Elaborative Mental Stance and Decoupling of Executive and Pain-Related Cortices Predicts Low Pain Sensitivity in Zen Meditators. Pain 2011, 152, 150–156. https://doi.org/10.1016/j.pain.2010.10.006.
Gard, T.; Holzel, B.K.; Sack, A.T.; Hempel, H.; Lazar, S.W.; Vaitl, D.; Ott, U. Pain Attenuation through Mindfulness Is Associated with Decreased Cognitive Control and Increased Sensory Processing in the Brain. Cereb. Cortex 2012, 22, 2692–2702. https://doi.org/10.1093/cercor/bhr352.
Vanhaudenhuyse, A.; Boly, M.; Balteau, E.; Schnakers, C.; Moonen, G.; Luxen, A.; Lamy, M.; Degueldre, C.; Brichant, J.F.; Maquet, P.; et al. Pain and Non-Pain Processing during Hypnosis: A Thulium-YAG Event-Related FMRI Study. NeuroImage 2009, 47, 1047–1054. https://doi.org/10.1016/j.neuroimage.2009.05.031.
Casiglia, E.; Finatti, F.; Tikhonoff, V.; Stabile, M.R.; Mitolo, M.; Albertini, F.; Gasparotti, F.; Facco, E.; Lapenta, A.M.; Venneri, A. Mechanisms of hypnotic analgesia explained by functional magnetic resonance (fMRI). Int. J. Clin. Expl. Hypn. 2020, 68, 1–15. https://doi.org/10.1080/00207144.2020.1685331.
Bicego, A.; Monseur, J.; Collinet, A.; Donneau, A.-F.; Fontaine, R.; Libbrecht, D.; Malaise, N.; Nyssen, A.-S.; Raaf, M.; Rousseaux, F.; et al. Complementary Treatment Comparison for Chronic Pain Management: A Randomized Longitudinal Study. PLoS ONE 2021, 16, e0256001. https://doi.org/10.1371/journal.pone.0256001.
Vanhaudenhuyse, A.; Gillet, A.; Malaise, N.; Salamun, I.; Grosdent, S.; Maquet, D.; Nyssen, A.-S.; Faymonville, M.-E. Psychological Interventions Influence Patients’ Attitudes and Beliefs about Their Chronic Pain. J. Tradit. Complement. Med. 2018, 8, 296–302. https://doi.org/10.1016/j.jtcme.2016.09.001.
Casanova, E.; Lazzari, R.E.; Lotta, S.; Mazzucchi, A. Locked-in Syndrome: Improvement in the Prognosis after an Early Intensive Multidisciplinary Rehabilitation11No Commercial Party Having a Direct Financial Interest in the Results of the Research Supporting This Article Has or Will Confer a Benefit upon the Author(s) or upon Any Organization with Which the Author(s) Is/Are Associated. Arch. Phys. Med. Rehabil. 2003, 84, 862–867. https://doi.org/10.1016/S0003-9993(03)00008-X.
Branco, M.P.; Pels, E.G.M.; Sars, R.H.; Aarnoutse, E.J.; Ramsey, N.F.; Vansteensel, M.J.; Nijboer, F. Brain-Computer Interfaces for Communication: Preferences of Individuals With Locked-in Syndrome. Neurorehabil. Neural Repair. 2021, 35, 267–279. https://doi.org/10.1177/1545968321989331.
Rousseau, M.-C.; Pietra, S.; Nadji, M.; Billette de Villemeur, T. Evaluation of Quality of Life in Complete Locked-In Syndrome Patients. J. Palliat. Med. 2013, 16, 1455–1458. https://doi.org/10.1089/jpm.2013.0120.
Khalili-Ardali, M.; Wu, S.; Tonin, A.; Birbaumer, N.; Chaudhary, U. Neurophysiological Aspects of the Completely Locked-in Syndrome in Patients with Advanced Amyotrophic Lateral Sclerosis. Clin. Neurophysiol. 2021, 132, 1064–1076. https://doi.org/10.1016/j.clinph.2021.01.013.
Svernling, K.; Törnbom, M.; Nordin, Å.; Sunnerhagen, K.S. Locked-in Syndrome in Sweden, an Explorative Study of Persons Who Underwent Rehabilitation: A Cohort Study. BMJ Open 2019, 9, e023185. https://doi.org/10.1136/bmjopen-2018-023185.
Corallo, F.; Bonanno, L.; Lo Buono, V.; De Salvo, S.; Rifici, C.; Pollicino, P.; Allone, C.; Palmeri, R.; Todaro, A.; Alagna, A.; et al. Augmentative and Alternative Communication Effects on Quality of Life in Patients with Locked-in Syndrome and Their Caregivers. J. Stroke Cerebrovasc. Dis. 2017, 26, 1929–1933. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.06.026.
Leonard, M.; Renard, F.; Harsan, L.; Pottecher, J.; Braun, M.; Schneider, F.; Froehlig, P.; Blanc, F.; Roquet, D.; Achard, S.; et al. Diffusion Tensor Imaging Reveals Diffuse White Matter Injuries in Locked-in Syndrome Patients. PLoS ONE 2019, 14, e0213528. https://doi.org/10.1371/journal.pone.0213528.
Lugo, Z.R.; Bruno, M.-A.; Gosseries, O.; Demertzi, A.; Heine, L.; Thonnard, M.; Blandin, V.; Pellas, F.; Laureys, S. Beyond the Gaze: Communicating in Chronic Locked-in Syndrome. Brain Inj. 2015, 29, 1056–1061. https://doi.org/10.3109/02699052.2015.1004750.