Addressing Pain for a Proper Rehabilitation Process in Patients With Severe Disorders of Consciousness

Riganello, Francesco; Soddu, Andrea; Tonin, Paolo

doi:10.3389/fphar.2021.628980

Cited by 6 publications

(7 citation statements)

References 113 publications

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“…Having a powerful alternative to treat the pain is relevant because it can positively impact the patient's wellness. 6,8 Based on the literature, we can speculate about the association between pain and other disorders. In cases of spasticity, pain is usually a consequence of abnormal muscle tone.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials

Coraci,

Maccarone,

Ragazzo

et al. 2024

Eur J Transl Myol

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Pain represents a common symptom of several diseases and is often associated with a reduction in rehabilitation outcomes and recovery. The effectiveness of pain alleviation by botulinum toxin has been recently demonstrated. We searched in PubMed the papers about this topic published in the last ten years, and we selected clinical trials, guidelines, meta-analyses, reviews, and systematic reviews. We used different approaches: multiperspective presentation, lexical evaluation, and systematic review. The systematic review was only performed for the randomized controlled trials. We predominantly found reviews and trials about the rehabilitation of stroke/brain injury and epicondylitis. The most common outcome measures were pain, function, and spasticity. Among the common words, pain was the most frequent and the terms were grouped into different families, especially concerning the outcomes. Rehabilitation showed a relatively low frequency. Finally, the systematic review showed moderate-low levels of bias which confirms the effectiveness of botulinum toxin for pain treatment. The current literature about botulinum toxin is wide and globally diffuse but with some limitations in study strategies and clearness in the formal presentation. The evidence justifies the use of botulinum toxin in treating pain in different diseases.

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Section: Discussionmentioning

confidence: 99%

Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials

Coraci,

Maccarone,

Ragazzo

et al. 2024

Eur J Transl Myol

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“…The patients who demonstrated nociceptive trace conditioning evolved to MCS within 4 weeks. This finding underscored the difficulty of correctly diagnosing DOC conditions through behavior, which can be made even more difficult by external factors, such as drug therapy ( Riganello et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients

et al. 2021

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The Nociception Coma Scale (NCS) and its revised version (NCS-R) were used to evaluate behavioral responses to pain in non-communicative patients. We hypothesized that if patients demonstrate changes to their NCS(-R) scores over time, their evolving behavioral abilities could indicate a forthcoming diagnostic improvement with the Coma Recovery Scale-Revised (CRS-R). Forty-three Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients were enrolled in the study. The patients were assessed weekly using the CRS-R and NCS(-R) for four consecutive weeks. The first assessment was within 10 days after hospitalization. The assessments were performed between 09:30 and 11:30 AM in a room with constant levels of humidity, light and temperature, as well as an absence of transient noise. Noxious stimuli were administered using a Newton-meter, with pressure applied to the fingernail bed for a maximum of 5 s unless interrupted by a behavioral response from subjects. Seventeen patients demonstrated improvements in their level of consciousness, 13 of whom showed significant behavioral changes through the NCS(-R) before being diagnosed with a Minimally Conscious State (MCS) according to the CRS-R. The behavioral changes observed using the NCS(-R) corresponded to a high probability of observing an improvement from VS/UWS to MCS. To characterize the increased likelihood of this transition, our results present threshold scores of ≥5 for the NCS (accuracy 86%, sensitivity 87%, and specificity 86%) and ≥3 for the NCS-R (accuracy 77%, sensitivity 89%, and specificity 73%). In conclusion, a careful evaluation of responses to nociceptive stimuli in DOC patients could constitute an effective procedure in assessing their evolving conscious state.

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“…However, the subjective nature of pain remains a fundamental aspect of the experience, and reporting on it becomes crucial, with the narrative approach being recommended to assess pain in subjects who can communicate (Figure 1, Table 2). Considering the current definition of pain, assessing it in non-communicative patients remains challenging [78]. The minimum intensity of a stimulus that is perceived as painful.…”

Section: Pain In Docmentioning

confidence: 99%

I Feel! Therefore, I Am from Pain to Consciousness in DOC Patients

Riganello

Tonin

Soddu

2023

IJMS

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Pain assessment and management in patients with disorders of consciousness (DOC) is a challenging and important aspect of care, with implications for detecting consciousness and promoting recovery. This narrative review explores the role of pain in consciousness, the challenges of pain assessment, pharmacological treatment in DOC, and the implications of pain assessment when detecting changes in consciousness. The review discusses the Nociception Coma Scale and its revised version, which are behavioral scales used to assess pain in DOC patients, and the challenges and controversies surrounding the appropriate pharmacological treatment of pain in these patients. Moreover, we highlight recent evidence suggesting that an accurate pain assessment may predict changes in the level of consciousness in unresponsive wakefulness syndrome/vegetative state patients, underscoring the importance of ongoing pain management in these patients.

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Addressing Pain for a Proper Rehabilitation Process in Patients With Severe Disorders of Consciousness

Cited by 6 publications

References 113 publications

Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials

Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials

Nociceptive Response Is a Possible Marker of Evolution in the Level of Consciousness in Unresponsive Wakefulness Syndrome Patients

I Feel! Therefore, I Am from Pain to Consciousness in DOC Patients

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