Frontiers in Integrative Neuroscience (Sep 2022)

Pain assessment during physiotherapy and noxious stimuli in patients with disorders of consciousness: A preliminary study

  • Jianzhong Shen,
  • Shanchun Tang,
  • Bingyang Yan,
  • Donghua Xie,
  • Tingting Fang,
  • Lidan Chen,
  • Guoyun Li

DOI
https://doi.org/10.3389/fnint.2022.962077
Journal volume & issue
Vol. 16

Abstract

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ObjectivesThe primary purpose of this study is to determine whether patients with disorders of consciousness (DOC) (unresponsive wakefulness syndrome, UWS; minimally conscious state, MCS) experience pain during physiotherapy and noxious stimuli in a larger patient population.Materials and methodsThe patients’ level of consciousness was measured with the Coma Recovery Scale-Revised (CRS-R). Additionally, the Nociception Coma Scale-revised (NCS-R) was used to assess their pain response. The NCS-R total scores between UWS and MCS at baseline, physiotherapy and noxious stimulus were compared using the Mann-Whitney U test (Wilcoxon rank-sum test) and the Kruskal-Wallis H test with Bonferroni correction.ResultsThe study enrolled 93 participants. There was a statistically significant difference in NCS-R total scores between the three conditions (H = 215.25, p < 0.001). At baseline, there was no statistically significant difference between MCS and UWS (U = 378, z = –1.35, p = 0.178). While there was a statistically significant difference between MCS and UWS during physiotherapy (U = 1,362, z = –3.06, p < 0.01) and under noxious stimuli (U = 5142.5, z = –11.22, p < 0.001).ConclusionPhysiotherapy improved the activity responsiveness of DOC patients, and patients experienced less potential pain. However, some DOC patients, especially MCS patients, perceived pain under the noxious stimuli.

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