Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review

Estelle A C Bonin; Nicolas Lejeune; Emilie Szymkowicz; Vincent Bonhomme; Charlotte Martial; Olivia Gosseries; Steven Laureys; Aurore Thibaut

doi:10.3389/fnsys.2023.1112206

Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review

Front Syst Neurosci. 2023 Mar 20:17:1112206. doi: 10.3389/fnsys.2023.1112206. eCollection 2023.

Authors

Estelle A C Bonin^{1

2}, Nicolas Lejeune^{1

3

4}, Emilie Szymkowicz^{1

2}, Vincent Bonhomme^{5

6}, Charlotte Martial^{1

2}, Olivia Gosseries^{1

2}, Steven Laureys^{1

2

7}, Aurore Thibaut^{1

2}

Affiliations

¹ Coma Science Group, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium.
² Centre du Cerveau2, Liège University Hospital, Liège, Belgium.
³ Centre Hospitalier Neurologique (CHN) William Lennox, Saint-Luc Hospital Group, Ottignies-Louvain-la-Neuve, Belgium.
⁴ Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
⁵ Department of Anesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium.
⁶ Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness Thematic Unit, GIGA-Research, Liège, Belgium.
⁷ Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSS), University Laval, Québec City, QC, Canada.

Abstract

The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.

Keywords: disorders of consciousness; locked-in syndrome; nociception; pain; pain assessment; pain management; theories of pain.

Publication types

Review

Grants and funding

This study was supported by the Liège University Hospital, the Belgian National Funds for Scientific Research (FRS-FNRS), the European Union’s Horizon 2020 Framework Program for Research and Innovation under the Specific Grant Agreement No. 945539 (Human Brain Project SGA3), the FNRS PDR project (T.0134.21), the ERA-Net FLAG-ERA JTC2021 project ModelDXConsciousness (Partnering Project – Human Brain Project), the fund Generet, the King Baudouin Foundation, the Télévie Foundation, the European Space Agency (ESA) and the Belgian Federal Science Policy Office (BELSPO) in the framework of the PRODEX Program, the Public Utility Foundation “Université Européenne du Travail,” “Fondazione Europea di Ricerca Biomedica,” the BIAL Foundation, the Mind Science Foundation, the European Commission, the Fondation Leon Fredericq, the Mind-Care Foundation, the DOCMA project (EU-H2020-MSCA–RISE–778234), the National Natural Science Foundation of China (Joint Research Project 81471100), and the European Foundation of Biomedical Research FERB Onlus. NL was post-doctoral fellow, AT and OG were a research associates, and SL was research director at FRS-FNRS.