Silvia Mónica Cárdenas Prado

University of São Paulo, Brazil

Presentation Title:

Pain recognition in patients with disorders of consciousness

Abstract

Background: One of the biggest unknowns of pain is the impossibility of manifesting it, or recognizing it.

Objectives: To evaluate and compare the nociception by score Nociception Coma Scale Revised NCR-S in patients with disorders of consciousness (DOC).

Methods:

1). In the first phase, patients with DOC were evaluated using the Coma Recovery Scale-Revised (CRS-R) to diagnose the type of DOC, either unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Subsequently, the Modified Glasgow Coma Scale with Pupil Score (GSC-P) was applied and the occurrence of pain was assessed using the NCS-R.

2). In a subgroup of patients with a cutoff of ≥5 points in the NCR-S evaluation was selected in order to evaluate the analgesic effect.

Results: In Phase 1 forty-two (75.0%) patients were UWS and 14 (25.0%) were MCS (p<;0.001). The mean values of the CRS-R scales were higher in the patients of the MCS group than in those of the UWS group, differences mainly due to the Auditory, Visual and Motor items. Strong positive correlations were observed for the whole sample between NCS-R and Glasgow scores (r=0.824; p<;0.001); between CRS-R/JF and GSC-P scores (r=0.829; p<;0.001) and between NCS-R and CRS-R/JF scores (r=0.804; p<;0.001). In the UWS group, a moderate positive correlation was also observed. In phase 2, in the NCS-R evaluation, the two groups showed similar mean behaviors between the evaluation moments.

Conclusion: In this study in patients with DOC categorized into UWS and MCS, we found that the UWS group had lower NCS-R scores than the MCS group in spite that both were homogenized in several sociodemographic and clinical variables. In addition, in the entire sample and in the UWS group, the three scales used (CRS-R, GCS-P and NCS-R) were positively correlated.

Keywords: Consciousness disorders, Pain management, Nociception Coma Scale-Revised, Minimally conscious state, Unresponsive wakefulness syndrome/vegetative state.

Biography

Silvia Mónica Cárdenas Prado, Peruvian-Brazilian scientist. Graduated in Human Medicine by the University Nacional Federico Villarreal (Lima, Peru, 1997). Specialization in Clinical Cardiology at Hospital Beneficência Portuguesa (Sao Paulo, Brazil, 1998-2000). Fellowship in medical Emergencies at the Hospital das Clinicas of the Faculty of Medicine of the University of São Paulo (2002-2003). Qualified Specialist in Intensive Care Medicine by the Brazilian Intensive Care Medicine Association - AMIB (2008). Postgraduate degree in Neurointensivism from Hospital Sírio-Libanês (São Paulo, 2011). Diretor of Critical Care Unit of Hospital Guaianazes (São Paulo, 2009-2017). She was currently Supervisor of the Intensive Care Unit at the Institute of Psychiatry at Hospital das Clínicas Universidade de São Paulo. Professor of the Clinical Emergency for Internship and resident doctors at the Municipal Hospital Professor Doutor Alípio Corrêa Netto – Ermelino Matarazzo.

Author of several scientific articles and book chapters. Coordinator of the Neurointensivism course at the USP Faculty of Medicine, since 2019.Master in neurology mainly addressing the area of disorders of consciousness. She has experience in the area of Intensive Medicine, with an emphasis on Neurointensivism.

3rd International Conference on Neurology and Mental Disorders

Silvia Mónica Cárdenas Prado

Presentation Title:

Pain recognition in patients with disorders of consciousness

Abstract

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