Nociception Coma Scale-Revised Allows to Identify Patients With Preserved Neural Basis for Pain Experience - 01/09/20
Highlights |
• | Fluorodeoxyglucose positron emission tomography confirmed unresponsive wakefulness syndrome showed a Nociception Coma Scale-Revised score below 5. |
• | Nociception Coma Scale-Revised cut-off score of 5 allowed to identify disorders of consciousness patients with potential pain. |
• | This is a first step toward providing better guidelines for pain management. |
Abstract |
The Nociception Coma Scale-Revised (NCS-R) was developed to help assess pain in patients with disorders of consciousness (DOC). Several studies have shown its sensitivity in assessing response to acute noxious stimuli. However, they failed to determine a reliable cut-off score that could be used to infer pain processing in these patients. This retrospective cross-sectional study aimed to determine a NCS-R cut-off score supporting preserved neural basis for pain experience, based on brain metabolism preservation as measured by fluorodeoxyglucose positron emission tomography (FDG-PET). We included patients in unresponsive wakefulness syndrome (UWS) confirmed by the FDG-PET and examined the NCS-R total scores. As the highest score was 4, we defined the cut-off to be 5 and compared the brain metabolism of these patients to matched patients with DOC and a NCS-R cut-off score ≥5 (ie, potential pain), as well as healthy subjects. We found a higher global cerebral metabolism in healthy subjects compared to both patient groups and also in patients with potential pain compared with FDG-PET confirmed UWS. We observed a preserved metabolism in the left insula in patients with potential pain compared with FDG-PET confirmed UWS.
Perspectives |
Our data suggest that using the cut-off score of 5 could be helpful to improve pain management in patients with DOC. Future studies should focus on patients showing scores below this cut-off to better characterize their profile and improve care.
Le texte complet de cet article est disponible en PDF.Key Words : Nociception, Pain, Cut-off score, Nociception coma scale-revised, Disorders of consciousness
Abbreviations : CRS-R, NCS-R, DOC, UWS, MCS, MCS*, FDG-PET, TP, FP, TN, FN
Plan
| Conflicts of interest: The authors declare that they have no conflict of interest. |
|
| Funding: The study was further supported by The University and University Hospital of Liege, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union’s Horizon 2020 Framework Programme for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Programme, “Fondazione Europea di Ricerca Biomedica”, the Bial Foundation, the Mind Science Foundation and the European Commission, the fund Generet, the King Baudouin Foundation, DOCMA project [EU-H2020-MSCA–RISE–778234]. AT and NL are post-doctoral fellows, and SL is research director at FRS-FNRS. |
Vol 21 - N° 5-6
P. 742-750 - mai 2020 Retour au numéro
Article précédent
- Sex Differences in Interleukin-6 Responses Over Time Following Laboratory Pain Testing Among Patients With Knee Osteoarthritis
- Chung Jung Mun, Janelle E. Letzen, Sabrina Nance, Michael T. Smith, Harpal S. Khanuja, Robert S. Sterling, Mark C. Bicket, Jennifer A. Haythornthwaite, Robert N. Jamison, Robert R. Edwards, Claudia M. Campbell
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?